Advances in automobile crashworthiness have reduced both fatalities and severe injuries with diff... more Advances in automobile crashworthiness have reduced both fatalities and severe injuries with different occupant restraint systems (seatbelts and airbags). However, even the appropriate use of these systems does not always completely prevent injury at the cranio-cervical junction in a high-energy accident. This report presents two such cases. Drivers should be educated not to place too much confidence in the safety provided by occupant restraint systems. In addition, physicians should pay attention to cranio-cervical trauma when a patient experiences cardiac arrest after a motor vehicle accident, even the patient is protected by occupant restraint systems.
DOI: 10.21276/sjmcr.2018.6.12.14 Abstract: A 33-year-old man was struck by a car. Whole body comp... more DOI: 10.21276/sjmcr.2018.6.12.14 Abstract: A 33-year-old man was struck by a car. Whole body computed tomography (CT) showed multiple injuries. After admission, he developed a high fever of unknown origin. He complicated with Enterobacter cloacae infection, following pulmonary and deep venous thrombosis in his right leg. Later, he was diagnosed with hemophagocytic lymphohistiocytosis (HLH). Finally, his general condition improved and he was transferred to a rehabilitation facility. This is the first report of a patient who developed pulmonary embolism followed by HLH as a complication of trauma. Overlapping enhanced inflammatory reactions caused by trauma, sepsis and PE may have induced HLH in the present case.
DOI: 10.21276/sjmcr.2018.6.9.28 Abstract: A 39-year-old man found himself unable to raise his bil... more DOI: 10.21276/sjmcr.2018.6.9.28 Abstract: A 39-year-old man found himself unable to raise his bilateral upper extremities when he stood after trying to grab a flag stuck into the sand by jumping and extending his upper extremities while over-extending his neck. He was transported to our hospital. On arrival, his vital signs were stable. He had bilateral motor weakness at the upper extremities and hyperesthesia at the bilateral C5-C7 area. His lower extremities were intact and functioning. Cervical computed tomography revealed cervical spur formation, and urgent magnetic resonance imaging disclosed disc herniation at the C3/C4 level with mild compression of the spinal cord. He was put on bed rest with a cervical collar. On the second hospital day, his motor weakness and hyperesthesia improved, and he was able to stand and walk as usual. He was discharged on foot that day and referred to a local hospital near his home. To our knowledge, this is the first case report of a spinal cord i...
DOI: 10.21276/sjmcr.2017.5.12.12 Abstract: The patient was a 55-year-old man who had fallen from ... more DOI: 10.21276/sjmcr.2017.5.12.12 Abstract: The patient was a 55-year-old man who had fallen from a height of 1.5 m when cutting a tree branch. He complained of face, chest, back, right femur and leg pain. He had hypertension and gastritis. He was diagnosed with cerebral concussion, right 8 and 9 th rib fractures, right hemopneumothorax, liver injury with ascites and pelvic and leg fractures by whole computed tomography (CT). He underwent right thoracotomy, and received oxygen and a fentanyl infusion. On the same day, follow-up CT revealed gastric emphysema (GE), air in the gastricomental vein and the portal vein of the liver with enlargement of the stomach. As he had no abdominal pain and signs of peritoneal stimulation, conservative therapy was selected. He survived and was discharged. A possible mechanism of GE was that massive amount of air associated with the enlargement of stomach due to paralysis, entered the site of an underlying gastric lesion and resulted in the gastric wal...
A 78-year-old man fell from a ladder and suffered a right distal tibial fracture. On the seventh ... more A 78-year-old man fell from a ladder and suffered a right distal tibial fracture. On the seventh day after injury, he developed a low-grade fever and was isolated in a private room. Polymerase chain reaction for COVID-19 was positive (day 4 from the day of saliva sampling). On day 5, he required 1 liter per minute of oxygen and dexamethasone therapy was initiated. On day 6, his D-dimer level was 25.0 μg/mL, and continuous infusion of heparin was initiated. From day 7, he was administered remdesivir. On day 9, his oxygenation suddenly showed a remarkable deterioration. He received a tentative diagnosis of COVID-19induced pneumonia accompanied by severe acute respiratory distress syndrome (ARDS) and underwent urgent tracheal intubation and mechanical ventilation. He also received intravenous immunoglobulin (IVIG) and was also administered glycyrrhizin. His oxygenation gradually improved and extubation was performed on day 15. Following rehabilitation, he did not require oxygen on day 19. On day 20, his D-dimer level was found to be increased and enhanced computed tomography revealed pulmonary embolism. He was prescribed a direct oral anticoagulant. On day 28 he was transferred to a general ward for rehabilitation. These unspecific antiviral therapies and immune modulation therapy may be useful treatments for the main cause of ARDS, which may explain the favorable outcome that was obtained in the present case.
Background The specific clinical feature of tetanus is whole body muscle spasms. These spasms are... more Background The specific clinical feature of tetanus is whole body muscle spasms. These spasms are intensely painful and sometime lead to some injuries. Vertebral fractures have been reported as a common complication of tetanus, however iliopsoas hematoma is a rare complication. We describe a case of iliopsoas hematoma in a tetanus patient who had not been treated with any anticoagulant or antiplatelet agents. Case presentation A 72-year-old female patient was transferred to our hospital 7 days after the onset of tetanus. An iliopsoas hematoma was identified in her right iliopsoas muscle on computed tomography. There was no extravasation; thus, the hematoma improved with conservative therapy. There were no episodes that suggested a bleeding tendency, or no factors associated with hemorrhagic conditions. Conclusion This is the first report of iliopsoas hematoma as a complication in a tetanus patient who did not received anticoagulation therapy. The possibility of IPH as a complication...
A 33-year-male with severe tetanus was first treated with muscle relaxant and dexmedetomidine or ... more A 33-year-male with severe tetanus was first treated with muscle relaxant and dexmedetomidine or propofol. However, due to the occurrence of side effects or the ineffectiveness in preventing muscle spasm of these drugs led us to convert them to continuous infusion of high dose magnesium sulphate for 21 days. This therapy was able to successfully prevent muscle spasm, avoid a sympathetic crisis and also enable the patient to communicate with healthcare providers. The patient was discharged on the 88th hospital day after undergoing rehabilitation. This is the first report of the case with severe tetanus who was treated with the continuous high dose infusion of magnesium sulphate in Japan. This therapy was therefore found to be effective and inexpensive for the treatment of severe tetanus.
In response to the Hanshin-Awaji Great Earthquake, disaster base hospitals, disaster medical assi... more In response to the Hanshin-Awaji Great Earthquake, disaster base hospitals, disaster medical assistance teams(DMATs)and the Emergency Medical Information System(EMIS)were established. As a staging care unit built and managed by the DMATs, victims were evacuated by Self-Defense Force airplanes or physician-staffed helicopters to unaffected areas. Although this system ran smoothly after this particular disaster, several associated problems remain unresolved. Several medical relief teams have been dispatched to manage disasters in recent years, thus underscoring the importance of organizing these teams properly and providing appropriate medical support for victims from the acute to the chronic phase.
、 Ve report a case of a ruptured cerebral aneurysm in spite of receiving MR angi 〔 〕 graphy (MRA)... more 、 Ve report a case of a ruptured cerebral aneurysm in spite of receiving MR angi 〔 〕 graphy (MRA)6months previously 、 A59 − year − old man lost consciousness and a head CT revealed a subarachnoid hem ｛ ｝ rrhage (SAH) ． Cerebral angiography exposed an aneurysm ， 9mm in diameter ， located at the anterior colnmullicathlg artery ． Aneurysmal neck clipping was performed and the postoperative course was uneventful ． The patient had received a brain checkup witll MRI and MRA due to hypertension experienced 2 years previously， and the MRA study f〔〕r further examination of amnesia 6 months before the SAH was discovered ． At the time ， the MRA was negative but retrospective analysis of the source image of the MRA exhibited the aneurysm ． To increase the accuracy of diagnosis of cerebral aneurysms using MRI devices ， not only must the MRA and the MR images be evaluated ， but the source images of the MRA must also be carefully evaluated ． If possible， three − dimensional CT angiography should also be used to detect aneurysms 、
Fig. 1 T 1-weighted magnetic resonance image with gadolinium demonstrating residual tumor in the ... more Fig. 1 T 1-weighted magnetic resonance image with gadolinium demonstrating residual tumor in the cerebellum (arrow).
A 17-year-old man presented with sleeping tendency, tenderness of the back of the neck, and left ... more A 17-year-old man presented with sleeping tendency, tenderness of the back of the neck, and left upper monoplegia after a motorcycle accident. Three-dimensional computed tomography on the 2nd hospital day clearly revealed a type I odontoid fracture. His injuries were treated conservatively and he was discharged on the 60th hospital day, with sequelae due to the cervical root avulsion injuries. Type I odontoid fracture is rare and may be caused by coronal distraction of the head and neck area.
Asymptomatic small hemorrhages were identified in hypertensive patients by T 2 *-weighted gradien... more Asymptomatic small hemorrhages were identified in hypertensive patients by T 2 *-weighted gradient echo magnetic resonance (MR) imaging to investigate the relationship between hypertensive intracerebral hemorrhage and asymptomatic minute hemorrhages. Forty-eight patients with hypertensive intracerebral hemorrhage or cerebral infarction with hypertension (these diseases were defined as stroke) were treated in National Defense Medical College from April 1998 to February 2000. All patients had no past history of stroke or head injury, underwent MR imaging within 6 months of the stroke attack, were aged from 40 to 80 years, and had no diagnosis of aneurysm, angioma, or moyamoya disease. Patients were divided into the infarction group and hemorrhage group. All foci over 2 mm in size appearing as hypointense on T 2 *-weighted MR imaging and unrelated to stroke areas were defined as minute hemorrhages. There were no significant differences between the two groups with respect to sex, age, and history of diabetes mellitus. The incidence of minute hemorrhages in the hemorrhage group (21/26) was greater than in the infarction group (9/22, p º 0.01). The incidence of minute hemorrhages in the basal ganglia (18/26) was greater in the hemorrhage group than in the infarction group (4/22, p º 0.001). Symptomatic intracerebral hemorrhage may be preceded by asymptomatic minute hemorrhage.
To investigate the effects of emergency burr hole drainage for acute subdural hematoma (ASDH) wit... more To investigate the effects of emergency burr hole drainage for acute subdural hematoma (ASDH) with bilateral non-reactive pupils. A retrospective study was conducted by reviewing medical records from 1998 to 2007. Patients meeting the following criteria were included: 1) head injury with unconsciousness (Glasgow Coma Scale score 8); 2) bilateral non-reactive pupils on arrival; 3) ASDH with disappearance of basal cistern on computed tomography (CT); and 4) performance of emergency single burr hole drainage. Subjects were divided into survival and non-survival groups. Pupil size on the small side was significantly smaller in the survival group than in the non-survival group. All pupils on the small side in the survival group were 4 mm. Emergency burr hole drainage should still be considered in patients with ASDH showing bilateral non-reactive pupils and one pupil 4 mm.
Clinical Medicine Insights: Trauma and Intensive Medicine, 2013
An 18-year-old youth soccer forward received a direct hit from a kicked soccer ball on the anteri... more An 18-year-old youth soccer forward received a direct hit from a kicked soccer ball on the anterior right chest when the goal keeper kicked the ball from a distance of 1 meter. Immediately following the hit, the subject experienced dypnea, chest pain and had a cough, with several milliliters of hemoptysis. His symptoms subsided after 20 minutes of rest. However, he still felt mild discomfort and was taken to our department for evaluation. On examination, all vital signs were normal. A computed tomography scan of the chest was obtained, and revealed a small area of opacification in the right lung field suggesting a pulmonary contusion or traumatic lung edema. Ten days after the initial injury, he was cleared for full participation. We herein reported the first case of a lung lesion induced by a soccer ball. Conservative treatment resulted in a favorable outcome.
Advances in automobile crashworthiness have reduced both fatalities and severe injuries with diff... more Advances in automobile crashworthiness have reduced both fatalities and severe injuries with different occupant restraint systems (seatbelts and airbags). However, even the appropriate use of these systems does not always completely prevent injury at the cranio-cervical junction in a high-energy accident. This report presents two such cases. Drivers should be educated not to place too much confidence in the safety provided by occupant restraint systems. In addition, physicians should pay attention to cranio-cervical trauma when a patient experiences cardiac arrest after a motor vehicle accident, even the patient is protected by occupant restraint systems.
DOI: 10.21276/sjmcr.2018.6.12.14 Abstract: A 33-year-old man was struck by a car. Whole body comp... more DOI: 10.21276/sjmcr.2018.6.12.14 Abstract: A 33-year-old man was struck by a car. Whole body computed tomography (CT) showed multiple injuries. After admission, he developed a high fever of unknown origin. He complicated with Enterobacter cloacae infection, following pulmonary and deep venous thrombosis in his right leg. Later, he was diagnosed with hemophagocytic lymphohistiocytosis (HLH). Finally, his general condition improved and he was transferred to a rehabilitation facility. This is the first report of a patient who developed pulmonary embolism followed by HLH as a complication of trauma. Overlapping enhanced inflammatory reactions caused by trauma, sepsis and PE may have induced HLH in the present case.
DOI: 10.21276/sjmcr.2018.6.9.28 Abstract: A 39-year-old man found himself unable to raise his bil... more DOI: 10.21276/sjmcr.2018.6.9.28 Abstract: A 39-year-old man found himself unable to raise his bilateral upper extremities when he stood after trying to grab a flag stuck into the sand by jumping and extending his upper extremities while over-extending his neck. He was transported to our hospital. On arrival, his vital signs were stable. He had bilateral motor weakness at the upper extremities and hyperesthesia at the bilateral C5-C7 area. His lower extremities were intact and functioning. Cervical computed tomography revealed cervical spur formation, and urgent magnetic resonance imaging disclosed disc herniation at the C3/C4 level with mild compression of the spinal cord. He was put on bed rest with a cervical collar. On the second hospital day, his motor weakness and hyperesthesia improved, and he was able to stand and walk as usual. He was discharged on foot that day and referred to a local hospital near his home. To our knowledge, this is the first case report of a spinal cord i...
DOI: 10.21276/sjmcr.2017.5.12.12 Abstract: The patient was a 55-year-old man who had fallen from ... more DOI: 10.21276/sjmcr.2017.5.12.12 Abstract: The patient was a 55-year-old man who had fallen from a height of 1.5 m when cutting a tree branch. He complained of face, chest, back, right femur and leg pain. He had hypertension and gastritis. He was diagnosed with cerebral concussion, right 8 and 9 th rib fractures, right hemopneumothorax, liver injury with ascites and pelvic and leg fractures by whole computed tomography (CT). He underwent right thoracotomy, and received oxygen and a fentanyl infusion. On the same day, follow-up CT revealed gastric emphysema (GE), air in the gastricomental vein and the portal vein of the liver with enlargement of the stomach. As he had no abdominal pain and signs of peritoneal stimulation, conservative therapy was selected. He survived and was discharged. A possible mechanism of GE was that massive amount of air associated with the enlargement of stomach due to paralysis, entered the site of an underlying gastric lesion and resulted in the gastric wal...
A 78-year-old man fell from a ladder and suffered a right distal tibial fracture. On the seventh ... more A 78-year-old man fell from a ladder and suffered a right distal tibial fracture. On the seventh day after injury, he developed a low-grade fever and was isolated in a private room. Polymerase chain reaction for COVID-19 was positive (day 4 from the day of saliva sampling). On day 5, he required 1 liter per minute of oxygen and dexamethasone therapy was initiated. On day 6, his D-dimer level was 25.0 μg/mL, and continuous infusion of heparin was initiated. From day 7, he was administered remdesivir. On day 9, his oxygenation suddenly showed a remarkable deterioration. He received a tentative diagnosis of COVID-19induced pneumonia accompanied by severe acute respiratory distress syndrome (ARDS) and underwent urgent tracheal intubation and mechanical ventilation. He also received intravenous immunoglobulin (IVIG) and was also administered glycyrrhizin. His oxygenation gradually improved and extubation was performed on day 15. Following rehabilitation, he did not require oxygen on day 19. On day 20, his D-dimer level was found to be increased and enhanced computed tomography revealed pulmonary embolism. He was prescribed a direct oral anticoagulant. On day 28 he was transferred to a general ward for rehabilitation. These unspecific antiviral therapies and immune modulation therapy may be useful treatments for the main cause of ARDS, which may explain the favorable outcome that was obtained in the present case.
Background The specific clinical feature of tetanus is whole body muscle spasms. These spasms are... more Background The specific clinical feature of tetanus is whole body muscle spasms. These spasms are intensely painful and sometime lead to some injuries. Vertebral fractures have been reported as a common complication of tetanus, however iliopsoas hematoma is a rare complication. We describe a case of iliopsoas hematoma in a tetanus patient who had not been treated with any anticoagulant or antiplatelet agents. Case presentation A 72-year-old female patient was transferred to our hospital 7 days after the onset of tetanus. An iliopsoas hematoma was identified in her right iliopsoas muscle on computed tomography. There was no extravasation; thus, the hematoma improved with conservative therapy. There were no episodes that suggested a bleeding tendency, or no factors associated with hemorrhagic conditions. Conclusion This is the first report of iliopsoas hematoma as a complication in a tetanus patient who did not received anticoagulation therapy. The possibility of IPH as a complication...
A 33-year-male with severe tetanus was first treated with muscle relaxant and dexmedetomidine or ... more A 33-year-male with severe tetanus was first treated with muscle relaxant and dexmedetomidine or propofol. However, due to the occurrence of side effects or the ineffectiveness in preventing muscle spasm of these drugs led us to convert them to continuous infusion of high dose magnesium sulphate for 21 days. This therapy was able to successfully prevent muscle spasm, avoid a sympathetic crisis and also enable the patient to communicate with healthcare providers. The patient was discharged on the 88th hospital day after undergoing rehabilitation. This is the first report of the case with severe tetanus who was treated with the continuous high dose infusion of magnesium sulphate in Japan. This therapy was therefore found to be effective and inexpensive for the treatment of severe tetanus.
In response to the Hanshin-Awaji Great Earthquake, disaster base hospitals, disaster medical assi... more In response to the Hanshin-Awaji Great Earthquake, disaster base hospitals, disaster medical assistance teams(DMATs)and the Emergency Medical Information System(EMIS)were established. As a staging care unit built and managed by the DMATs, victims were evacuated by Self-Defense Force airplanes or physician-staffed helicopters to unaffected areas. Although this system ran smoothly after this particular disaster, several associated problems remain unresolved. Several medical relief teams have been dispatched to manage disasters in recent years, thus underscoring the importance of organizing these teams properly and providing appropriate medical support for victims from the acute to the chronic phase.
、 Ve report a case of a ruptured cerebral aneurysm in spite of receiving MR angi 〔 〕 graphy (MRA)... more 、 Ve report a case of a ruptured cerebral aneurysm in spite of receiving MR angi 〔 〕 graphy (MRA)6months previously 、 A59 − year − old man lost consciousness and a head CT revealed a subarachnoid hem ｛ ｝ rrhage (SAH) ． Cerebral angiography exposed an aneurysm ， 9mm in diameter ， located at the anterior colnmullicathlg artery ． Aneurysmal neck clipping was performed and the postoperative course was uneventful ． The patient had received a brain checkup witll MRI and MRA due to hypertension experienced 2 years previously， and the MRA study f〔〕r further examination of amnesia 6 months before the SAH was discovered ． At the time ， the MRA was negative but retrospective analysis of the source image of the MRA exhibited the aneurysm ． To increase the accuracy of diagnosis of cerebral aneurysms using MRI devices ， not only must the MRA and the MR images be evaluated ， but the source images of the MRA must also be carefully evaluated ． If possible， three − dimensional CT angiography should also be used to detect aneurysms 、
Fig. 1 T 1-weighted magnetic resonance image with gadolinium demonstrating residual tumor in the ... more Fig. 1 T 1-weighted magnetic resonance image with gadolinium demonstrating residual tumor in the cerebellum (arrow).
A 17-year-old man presented with sleeping tendency, tenderness of the back of the neck, and left ... more A 17-year-old man presented with sleeping tendency, tenderness of the back of the neck, and left upper monoplegia after a motorcycle accident. Three-dimensional computed tomography on the 2nd hospital day clearly revealed a type I odontoid fracture. His injuries were treated conservatively and he was discharged on the 60th hospital day, with sequelae due to the cervical root avulsion injuries. Type I odontoid fracture is rare and may be caused by coronal distraction of the head and neck area.
Asymptomatic small hemorrhages were identified in hypertensive patients by T 2 *-weighted gradien... more Asymptomatic small hemorrhages were identified in hypertensive patients by T 2 *-weighted gradient echo magnetic resonance (MR) imaging to investigate the relationship between hypertensive intracerebral hemorrhage and asymptomatic minute hemorrhages. Forty-eight patients with hypertensive intracerebral hemorrhage or cerebral infarction with hypertension (these diseases were defined as stroke) were treated in National Defense Medical College from April 1998 to February 2000. All patients had no past history of stroke or head injury, underwent MR imaging within 6 months of the stroke attack, were aged from 40 to 80 years, and had no diagnosis of aneurysm, angioma, or moyamoya disease. Patients were divided into the infarction group and hemorrhage group. All foci over 2 mm in size appearing as hypointense on T 2 *-weighted MR imaging and unrelated to stroke areas were defined as minute hemorrhages. There were no significant differences between the two groups with respect to sex, age, and history of diabetes mellitus. The incidence of minute hemorrhages in the hemorrhage group (21/26) was greater than in the infarction group (9/22, p º 0.01). The incidence of minute hemorrhages in the basal ganglia (18/26) was greater in the hemorrhage group than in the infarction group (4/22, p º 0.001). Symptomatic intracerebral hemorrhage may be preceded by asymptomatic minute hemorrhage.
To investigate the effects of emergency burr hole drainage for acute subdural hematoma (ASDH) wit... more To investigate the effects of emergency burr hole drainage for acute subdural hematoma (ASDH) with bilateral non-reactive pupils. A retrospective study was conducted by reviewing medical records from 1998 to 2007. Patients meeting the following criteria were included: 1) head injury with unconsciousness (Glasgow Coma Scale score 8); 2) bilateral non-reactive pupils on arrival; 3) ASDH with disappearance of basal cistern on computed tomography (CT); and 4) performance of emergency single burr hole drainage. Subjects were divided into survival and non-survival groups. Pupil size on the small side was significantly smaller in the survival group than in the non-survival group. All pupils on the small side in the survival group were 4 mm. Emergency burr hole drainage should still be considered in patients with ASDH showing bilateral non-reactive pupils and one pupil 4 mm.
Clinical Medicine Insights: Trauma and Intensive Medicine, 2013
An 18-year-old youth soccer forward received a direct hit from a kicked soccer ball on the anteri... more An 18-year-old youth soccer forward received a direct hit from a kicked soccer ball on the anterior right chest when the goal keeper kicked the ball from a distance of 1 meter. Immediately following the hit, the subject experienced dypnea, chest pain and had a cough, with several milliliters of hemoptysis. His symptoms subsided after 20 minutes of rest. However, he still felt mild discomfort and was taken to our department for evaluation. On examination, all vital signs were normal. A computed tomography scan of the chest was obtained, and revealed a small area of opacification in the right lung field suggesting a pulmonary contusion or traumatic lung edema. Ten days after the initial injury, he was cleared for full participation. We herein reported the first case of a lung lesion induced by a soccer ball. Conservative treatment resulted in a favorable outcome.
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Papers by 洋一 柳川