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Invasive group B streptococcal infection in a patient with post splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension

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World Journal of Emergency Medicine 2016年第1期7卷 68-70页

作者： Tomoya Okazaki toru hifumi Arisa Manabe Hikari Matsumura Satoshi Egawa Hideyuki Hamaya Nastuyo Shinohara Koshiro Takano Hajime Shishido Yuko Abe Kenya Kawakita Masanobu Hagiike Yasuhiro Kuroda Emergency Medical Center Kagawa University Hospital Kita Kagawa 761-0793 Japan

BACKGROUND:Splenectomy in patients with liver cirrhosis(LC)is expected to become more common owing to its efficacy on portal *** this report we describe an alarming case of group B streptococcus(GBS)infection after splenectomy in a patient with ***:A 72-year-old woman with a history of LC was admitted to our emergency department because of respiratory *** patient had received left lateral segmentectomy of the liver and splenectomy three months before *** examination revealed significant wheezing during inspiration and expiration,but no crackles and *** radiography and CT showed no infiltrates.A presumptive diagnosis of bronchial asthma caused by upper respiratory infection was *** days after admission,GBS infection was confirmed by blood culture and penicillin G was *** were given intravenously for a total of 12 ***:The patient was discharged on the 12th day after ***:Although efficacy of splenectomy in patients with LC has been reported,immune status should be evaluated for a longer *** who have undergone splenectomy are highly susceptible to bacteria;moreover,LC itself is an independent risk factor for mortality in patients with *** prophylaxis against GBS has not been established,immediate action should be *** physicians should be aware of invasive GBS infection in the context of the critical risk factors related to splenectomy and LC,particularly the expected increase of splenectomy performed in LC patients.

关键词： Group B streptococcal infection Splenectomy Liver cirrhosis

A minimally invasive multiple percutaneous drainage technique for acute necrotizing pancreatitis

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World Journal of Emergency Medicine 2014年第4期5卷 310-312页

作者： Takero Terayama toru hifumi Nobuaki Kiriu Hiroshi Kato Yuichi Koido Yoshiaki Ichinose Kohei Morimoto Kuroda Yasuhiro Division of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Emergency Medical Center Kagawa University Hospital Division of Radiology National Hospital Organization Disaster Medical Center

BACKGROUND: In approximately 20% of patients, necrotizing pancreatitis is complicated with severe acute pancreatitis, with high morbidity and mortality rates. Minimally invasive step-up approach is both safe and effective, but sometimes requires multiple access ***: A 62-year-old woman was admitted with diabetic ketoacidosis, and initial computed tomography(CT) revealed no evidence of acute pancreatitis. She was clinically improved with insulin therapy, fl uid administration, and electrolyte replacement. However, on the 14 th day of admission, she developed a high-grade fever, and CT demonstrated evidence of acute necrotizing pancreatitis with a large collection of peripancreatic fl uid. Percutaneous transgastric drainage was performed and a 14 French gauge(Fr) pigtail catheter was placed 1 week later, which drained copious pus. Because of persistent high-grade fever and poor clinical improvement, multiple 8 and 10 Fr pigtail catheters were placed via the initial drainage route, allowing the safe and effective drainage of the extensive necrotic tissue that was occupying the bilateral anterior pararenal ***: After drainage, the patient recovered well and the last catheter was removed on day 123 of ***: Multiple percutaneous drainage requires both careful judgment and specialist skills. The perforation of the colon and small bowel as well as the injury of the kidney and major vessels can occur. The current technique appears to be safe and minimally invasive compared with other drainage methods in patients with extended, infected necrotic pancreatic pseudocysts.

关键词： Percutaneous drainage Acute necrotizing pancreatitis Minimally invasive technique

Thyroid hormone alterations in trauma patients requiring massive transfusion: An observational study

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World Journal of Emergency Medicine 2014年第4期5卷 270-274页

作者： toru hifumi Ichiro Okada Nobuaki Kiriu Eiju Hasegawa Tomoko Ogasawara Hiroshi Kato Yuichi Koido Junichi Inoue Yuko Abe Kenya Kawakita Masanobu Hagiike Yasuhiro Kuroda Emergency Medical Center Kagawa University Hospital Division of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Division of Critical Care Medicine and Trauma Yamanashi Prefectural Central Hospital

BACKGROUND: Although non-thyroidal illness syndrome(NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine(f T3) levels in trauma patients requiring massive transfusion have not been ***: A prospective observational study comparing 2 groups of trauma patients was conducted. Group M comprised trauma patients requiring massive transfusions(>10 units of packed red blood cells) within 24 hours of emergency admission. Group C comprised patients with an injury severity score >9 but not requiring massive transfusions. Levels of f T3, free thyroxine(f T4), and thyroidstimulating hormone(TSH) were evaluated on admission and on days 1, 2, and 7 after admission. The clinical backgrounds and variables measured including total transfusion amounts were compared and the inter-group prognosis was evaluated. Results are presented as mean±standard ***: Nineteen patients were enrolled in each group. In both groups, 32 were men, and the mean age was 50±24 years. In group C one patient died from respiratory failure. The initial f T3 levels in group M(1.95±0.37 pg/m L) were signifi cantly lower than those in group C(2.49±0.72 pg/m L; P<0.01) and remained low until 1 week after admission. Initial inter-group f T4 and TSH levels were not significantly different. TSH levels at 1 week(1.99±1.64 μIU/m L) were higher than at admission(1.48±0.5 μIU/m L) in group C(P<0.05).CONCLUSION: Typical NTIS was observed in trauma patients requiring massive transfusions. When initial resuscitation achieved circulatory stabilization, prognosis was not strongly associated with NTIS.

关键词： Non-thyroidal illness syndrome Massive transfusion Trauma Freetriiodothyronine Thyroid hormone