1.A Case of Above Knee Amputation with Preoperative High Risks
Hiroki Kinugawa ; Yasuyuki Shimada
Journal of Rural Medicine 2014;9(2):90-92
An 85-year-old malnourished man was admitted with ischemia-induced necrosis of the rightleg and high-risk factors, including chronic obstructive pulmonary disease, pneumonia, andinfection of the necrotic leg. We controlled the infection and provided proper nutrition.Using light general anesthesia and a nerve block, we amputated the leg above the knee. Thepatient could eat and drink the same day following the surgery, and respiratoryrehabilitation was begun the next day. His postoperative course was uneventful. Our casesuggests that maintenance of good nutrition may play a key role for high-risk eldersundergoing leg amputation.
2.A Case of Above Knee Amputation with Preoperative High Risks
Hiroki Kinugawa ; Yasuyuki Shimada
Journal of Rural Medicine 2014;():-
An 85-year-old malnourished man was admitted with ischemia-induced necrosis of the right leg and high-risk factors, including chronic obstructive pulmonary disease, pneumonia, and infection of the necrotic leg. We controlled the infection and provided proper nutrition. Using light general anesthesia and a nerve block, we amputated the leg above the knee. The patient could eat and drink the same day following the surgery, and respiratory rehabilitation was begun the next day. His postoperative course was uneventful. Our case suggests that maintenance of good nutrition may play a key role for high-risk elders undergoing leg amputation.
3.Tapenatadol Induced Hyperactive Delirium: Report of One Case Successfully Managed with Opioid-switching
Takefumi Nishimoto ; Megumi Hirooka ; Reiko Bukawa ; Hiroki Kodaira ; Tetsuya Takahashi ; Runa Shimada ; Ikuo Gomyo
Palliative Care Research 2016;11(2):525-528
Introduction: This report describes a case of hyperactive delirium induced by tapenatadol whose symptoms were successfully managed with opioid-switching to oxycodon. Case: A 67-year-old female, who had been treated with chemotherapy for malignant thymoma, had to stop chemotherapy because of her carcinomatous pericarditis. Tapentadol 200 mg per day was administrated for her unbearable chest wall tumor invasion-related somatic pain. After a while, insomnia, visual hallucination, thought disturbance, and attention disturbance were appeared. We diagnosed as hyperactive delirium. Because her somatic pain was favorably controlled by tapentadol, we additionally administered quetiapine 50 mg per day instead of replacing tapentadol. Unfortunately, quetiapine was not effective for the delirium. We therefore switched opioids from tapentadol to oxycodon. The delirium was remitted soon after the switching without relapsing of the pain. Conclusion: Tapentadaol reportedly induce hyperactive delirium via its noradrenaline reuptake inhibitory action. This case suggests that switching tapenatadol to other opioid could be an effective option for opioid induced delirium.
4. Usefulness of Virtual 3D image analysis in laparoscopic gastrectomy for trainee surgeons
Masaaki NISHI ; Kozo YOSHIKAWA ; Jun HIGASHIJIMA ; Takuya TOKUNAGA ; Toshihiro NAKAO ; Chie TAKASU ; Shohei ETO ; Hiroki TERAOKU ; Mistuo SHIMADA
Innovation 2014;8(4):114-115
Background: Laparoscopic gastrectomy has several difficult points including,lymph node dissection and resection of several blood vessels for trainee surgeons.Recently, preoperative evaluation of vasculature based three-dimensional (3D)imaging technique resulted in a significantly improved clinical outcome inabdominal surgery. The aim of this study is to investigate the usefulness of the 3Dimage in laparoscopic gastrectomy for trainee surgeons.Method: We adopted a multiphase CT protocol to acquire 3 image sets (arterial,portal, and equilibrium phases). 3D-reconstruction of gastric vasculature wasmade using data from a contrast enhanced MDCT and SYNAPSE VINCENTsoftware. Whole pancreas, spleen, gastric vasculature were extracted from MDCTscans and traced. Thirty three patients, who underwent laparoscopic gastrectomyfor gastric cancer during the period between Jan 2013 and May 2014 wereexamined in this study. Four trainees performed a 19 laparoscopic gastrectomy,while 14 laparoscopic gastrectomy were conducted by the two trainers. Thesurgical outcomes in both groups and the pattern of gastric vasculatures wereevaluated.Result: 3D imaging technique showed a correct positional relationship betweenthe stomach, gastric vessels, pancreas and spleen. Surgical outcome includingestimated blood loss, and operative time in trainee group were not significantlydifferent compared to trainer group. 3D imaging technique showed a correctpositional relationship between the stomach, gastric vessels, pancreas and spleen.Regarding vascular pattern detected by 3D imaging, the origins of IPA were RGEAin 12 cases (36%), GDA in 8 cases (24%).bifurcation of RGEA and GDA in7 cases(21%), and not detected in 1 case (3%), respectively. The types of confluence ofIPV were RGEV in 16 cases (48%), ASPDV in 10 cases (30%), and not detectedin 7 cases (21%), respectively.Conclusions: 3D imaging technique might contribute to successful laparoscopicgastrectomy. Preoperative 3D-simulation techniques enabled trainee surgeons toeasily and safely perform laparoscopic gastrectomy.
5.Kampo Treatment Experience in a Case of Suspected MRSA Infection Related Enteritis Complicated by ARDS and Shock
Tatsuya NOGAMI ; Naotoshi SHIBAHARA ; Makoto FUJIMOTO ; Hidetoshi WATARI ; Shigeru EBISAWA ; Hiroki MISAWA ; Hideyuki KITAHARA ; Sayuri ARAI ; Hiroaki HIKIAMI ; Yutaka SHIMADA
Kampo Medicine 2014;65(2):94-99
The patient was a 49-year-old woman. She developed retroperitonitis and retroperitoneal emphysema due to iatrogenic duodenal perforation. We inserted a nasogastric tube into her stomach in order to decompress the gastrointestinal tract, and cefoperazone and proton pump inhibitors were administered intravenously. Her symptoms of retroperitonitis were then reduced. However, she developed enteritis suspected due to MRSA infection complicated by acute respiratory distress syndrome, acute renal failure and shock. We administered vancomycin via nasogastric tube, but her symptoms did not improve, so we added shojokito. She relieved her bowels after the administration of shojokito, and an antipyretic tendency was observed. Her breathing status recovered to normal, her blood pressure was stable, and her general condition gradually improved.
In recent years, we have not had many opportunities to perform Kampo treatment for severe infection cases needing hospitalization, but Kampo application has the potential to enhance the efficacy of infection treatments. Thus we advocate the active carrying out of Kampo treatment for patients with intestinal infection.
6.Case Reports of Polymyalgia Rheumatica Successfully Treated with Kampo Medicines
Hiroaki HIKIAMI ; Naotoshi SHIBAHARA ; Masafumi MURAI ; Yutaka NAGATA ; Hiroki INOUE ; Kiyotaka YAGI ; Makoto FUJIMOTO ; Hirozo GOTO ; Yutaka SHIMADA
Kampo Medicine 2010;61(5):699-707
We report 5 patients with polymyalgia rheumatica (PMR) successfully treated with Kampo medicines. In total, we investigated 10 patients with PMR, including the 5 patients here treated in our department. Results showed that Kampo medicine was effective in 6 cases. One of the 6 refused steroid drug administration, and tapering dosage steroid was difficult in the other 5 patients due to myalgia or inflammation. Except for one case, C-reactive protein in most of the effective cases was below 3.0 mg/dl. On the other hand, the non-effective cases had severe inflammation levels and needed steroid therapy. The effective cases were treated with sokeikakketsuto, tokakujokito, keishibukuryogan, choyotokasyakuyaku, yokuibushihaishosan and tokishakuyakusan, which have the effect of improving oketsu states. Thus, it was considered that Kampo medicine has the potential for treatments in PMR patients who have difficulty tapering steroid dosage and mild inflammation. Moreover, this suggests Kampo medicines that improve oketsu state are useful for PMR treatment.
7.A Study of Indications for the Application of Kyokatsushoshitsuto
Hiroki MISAWA ; Tatsuya NOGAMI ; Hiroaki HIKIAMI ; Sayuri ARAI ; Hideyuki KITAHARA ; Shigeru EBISAWA ; Hidetoshi WATARI ; Makoto FUJIMOTO ; Naotoshi SHIBAHARA ; Yutaka SHIMADA
Kampo Medicine 2014;65(4):293-297
Kyokatsushoshitsuto is a Kampo formulation used against cervix pain so severe that the neck cannot be turned. Of six patients we treated with this formula, it was effective in three cases but ineffective in the remaining three. From the viewpoint of traditional Chinese medicine (Kampo) regarding the in/effectiveness of this formula : in effective cases, palpitations in the area of the navel and tooth marks on the tongue are seen in patients in a weak state. As for subjective symptoms : in effective cases, “the waist area around the body sometimes feels cold”, “air conditioning is disliked”, and “an electric blanket etc. is needed in winter” were also indicative signs. On the other hand, symptoms such as “the skin becomes dry”, “water may accumulate in a joint”, and “symptoms of clicking/pain in the knee and having difficulty sitting straight” were not seen. In total, these may serve as useful indications for the application of kyokatsushoshitsuto, especially when palpitations in the navel area are considered a helpful new Kampo finding.
8.A Case Report of an Obstinate Belch Successfully Treated with Goshuyuto
Hiroki INOUE ; Hiroshi OKA ; Kiyotaka YAGI ; Tatsuya NOGAMI ; Ryosuke OBI ; Hiroaki HIKIAMI ; Hirozo GOTO ; Naotoshi SHIBAHARA ; Yutaka SHIMADA
Kampo Medicine 2007;58(5):861-865
We report a case of an obstinate belch successfully treated with goshuyuto. The patient was a 74-year-old female. She had been hospitalized seven times in the past due to the belch, abdominal distention and anorexia, and had been prescribed various Kampo formulas. But her symptoms fluctuated up and down. The obstinate belch essentially disappeared after administering goshuyuto, and her appetite improved. Many of Kampo formulas that treat belchs are related to Shoyobyo (shao yang bing), but we consider that goshuyuto may be effective for a belch, which is yin-related and accompanied with stiffness and rigidity below the heart, and fullness in the chest and hypochondrium.
Medicine, Kampo
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Treated with
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Case Report
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plastic property - rigidity
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symptoms <1>
9.A Case of Adhesive Ileus Successfully Treated with Shojokito
Kiyotaka YAGI ; Hiroshi OKA ; Tatsuya NOGAMI ; Hiroki INOUE ; Sinji NAKADA ; Kazuya NOZAKI ; Hiroaki HIKIAMI ; Hirozo GOTO ; Naotoshi SHIBAHARA ; Yutaka SHIMADA
Kampo Medicine 2007;58(6):1133-1137
We report a case of recurring adhesive ileus that was successfully treated with shojokito (decoction) without inserting a nasogastric tube. The patient was a 75-year-old male who had been treated for abdominal symptoms in our department after a laparotomy. He visited our hospital mainly for complaints of abdominal pain and distention, was diagnosed with adhesive ileus because of a niveau image upon abdominal X-ray, and was hospitalized the same day. We diagnosed him as Yang syndrome and excess syndrome because he had thick yellow fur of the tongue, and administered shojokito. He broke wind at 40 minutes after administration of shojokito, and had bowel movement two hours later. Furthermore, he had mass diarrhea after another administration of this formula, and the niveau image disappeared the next day. It is often considered that an ileus develops with Cold, for which daikenchuto is prescribed frequently. However, in some cases cold purgative formulas such as jokito group may be effective, if such cases are Yang syndrome and excess syndrome, and present with yellow fur of the tongue.
Intestinal Obstruction
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Syndrome
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Treated with
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Yellow color
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Yang
10.Usefulness of Virtual 3D image analysis in laparoscopic gastrectomy for trainee surgeons
Masaaki Nishi ; Kozo Yoshikawa ; Jun Higashijima ; Takuya Tokunaga ; Toshihiro Nakao ; Chie Takasu ; Shohei Eto ; Hiroki Teraoku ; Mistuo Shimada
Innovation 2014;8(4):114-115
Background: Laparoscopic gastrectomy has several difficult points including,
lymph node dissection and resection of several blood vessels for trainee surgeons.
Recently, preoperative evaluation of vasculature based three-dimensional (3D)
imaging technique resulted in a significantly improved clinical outcome in
abdominal surgery. The aim of this study is to investigate the usefulness of the 3D
image in laparoscopic gastrectomy for trainee surgeons.
Method: We adopted a multiphase CT protocol to acquire 3 image sets (arterial,
portal, and equilibrium phases). 3D-reconstruction of gastric vasculature was
made using data from a contrast enhanced MDCT and SYNAPSE VINCENT
software. Whole pancreas, spleen, gastric vasculature were extracted from MDCT
scans and traced. Thirty three patients, who underwent laparoscopic gastrectomy
for gastric cancer during the period between Jan 2013 and May 2014 were
examined in this study. Four trainees performed a 19 laparoscopic gastrectomy,
while 14 laparoscopic gastrectomy were conducted by the two trainers. The
surgical outcomes in both groups and the pattern of gastric vasculatures were
evaluated.
Result: 3D imaging technique showed a correct positional relationship between
the stomach, gastric vessels, pancreas and spleen. Surgical outcome including
estimated blood loss, and operative time in trainee group were not significantly
different compared to trainer group. 3D imaging technique showed a correct
positional relationship between the stomach, gastric vessels, pancreas and spleen.
Regarding vascular pattern detected by 3D imaging, the origins of IPA were RGEA
in 12 cases (36%), GDA in 8 cases (24%).bifurcation of RGEA and GDA in7 cases
(21%), and not detected in 1 case (3%), respectively. The types of confluence of
IPV were RGEV in 16 cases (48%), ASPDV in 10 cases (30%), and not detected
in 7 cases (21%), respectively.
Conclusions: 3D imaging technique might contribute to successful laparoscopic
gastrectomy. Preoperative 3D-simulation techniques enabled trainee surgeons to
easily and safely perform laparoscopic gastrectomy.