JaLCDOI 10.18926/AMO/54987
FullText URL 71_2_179.pdf
Author Nosaka, Nobuyuki| Tsukahara, Kohei| Knaup, Emily| Yabuuchi, Toshihiko| Kikkawa, Tomonobu| Fujii, Yosuke| Yashiro, Masato| Yasuhara, Takao| Okada, Ayumi| Ugawa, Toyomu| Nakao, Atsunori| Tsukahara, Hirokazu| Date, Isao|
Abstract Newly published clinical practice guidelines recommend intracranial pressure (ICP) monitoring in critical care for the management of pediatric acute encephalopathy (pAE), but the utility of ICP monitoring for pAE has been poorly studied. We recently performed direct ICP monitoring for two patients. We observed that although the direct ICP monitoring had clinical benefits with less body weight gain and no vasopressor use in both cases, this monitoring technique is still invasive. Future studies should determine the utility of non-invasive ICP monitoring systems in pAE to further improve the quality of intensive-care management.
Keywords cerebral perfusion encephalopathy child intracranial pressure neurological intensive care
Amo Type Short Communication
Published Date 2017-04
Publication Title Acta Medica Okayama
Volume volume71
Issue issue2
Publisher Okayama University Medical School
Start Page 179
End Page 180
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2017 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 28420900
JaLCDOI 10.18926/AMO/54590
FullText URL 70_5_331.pdf
Author Iida, Atsuyoshi| Nosaka, Nobuyuki| Yumoto, Tetsuya| Knaup, Emily| Naito, Hiromichi| Nishiyama, Chihiro| Yamakawa, Yasuaki| Tsukahara, Kohei| Terado, Michihisa| Sato, Keiji| Ugawa, Toyomu| Nakao, Atsunori|
Abstract In recent years, it has become evident that molecular hydrogen is a particularyl effective treatment for various disease models such as ischemia-reperfusion injury; as a result, research on hydrogen has progressed rapidly. Hydrogen has been shown to be effective not only through intake as a gas, but also as a liquid medication taken orally, intravenously, or locally. Hydrogenʼs effectiveness is thus multifaceted. Herein we review the recent research on hydrogen-rich water, and we examine the possibilities for its clinical application. Now that hydrogen is in the limelight as a gaseous signaling molecule due to its potential ability to inhibit oxidative stress signaling, new research developments are highly anticipated.
Keywords hydrogen antioxidant effect medical gas gaseous signaling molecule clinical tests
Amo Type Review
Published Date 2016-10
Publication Title Acta Medica Okayama
Volume volume70
Issue issue5
Publisher Okayama University Medical School
Start Page 331
End Page 337
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2016 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 27777424
Web of Science KeyUT 000388098700001
Title Alternative Non-high-output cardiac failure in patients undergoing hemodialysis through an arteriovenous shunt
FullText URL 127_203.pdf
Author Ugawa, Toyomu|
Abstract Background: Hemodialysis-related heart failure has been considered to be associated with excessive blood flow through the arteriovenous (AV) shunt used for vascular access. However, some patients undergoing dialysis have heart failure in the absence of an increase in cardiac output (CO) related to shunt blood-flow loading because the loading cannot be compensated for by increasing CO. This condition may be challenging to manage ; thus, early diagnosis is important. Methods and Results: Twelve patients (mean age, 71 years ; 9 men) with end-stage renal disease, dialysis-related heart failure, a high brain natriuretic peptide (BNP) level, and a mean New York Heart Association (NYHA) class of II underwent AV shunt closure. Their cardiac index (CI), pre- and post-dialysis BNP levels, and several cardiac variables were assessed pre- and postoperatively. All patients achieved relief of heart failure symptoms and a reduction in NYHA class after AV closure, but six patients had a postoperative increase in CI (the "non-high-output" cardiac failure group), whereas the other six had a decrease in CI (the "high-output" cardiac failure group). The high-output patients had greater improvements in BNP levels and most cardiac variables compared to the non-high-output group ; therefore, the heart failure in the non-high-output patients was considered more serious than that in the high-output group. Conclusions: The selection of effective strategies for treating dialysis-related heart failure may depend partly on identifying which patients have non-high-output failure. Such identification requires serial measurements of BNP levels and evaluations of cardiac variables other than the ejection fraction.
Keywords 心拍出量(cardiac output) 心不全(heart failure) 脳性ナトリウム利尿ペプチド(brain natriuretic peptide) 非過大シャント心不全(non-high-output cardiac failure) 腎臓(kidney)
Publication Title 岡山医学会雑誌
Published Date 2015-12-01
Volume volume127
Issue issue3
Start Page 203
End Page 207
ISSN 0030-1558
Related Url isVersionOf https://doi.org/10.4044/joma.127.203
language 日本語
Copyright Holders Copyright (c) 2015 岡山医学会
File Version publisher
DOI 10.4044/joma.127.203
NAID 130005116810
JaLCDOI 10.18926/AMO/53673
FullText URL 69_5_275.pdf
Author Nosaka, Nobuyuki| Goda, Yu| Knaup, Emily| Tsukahara, Kohei| Yumoto, Tetsuya| Ugawa, Toyomu| Ujike, Yoshihito|
Abstract We sought to identify the incidence, injury patterns, and financial burden of ladder fall injuries to provide a reference for reinforcing guidelines on the prevention of such injuries. We enrolled the patients who were injured in a ladder-related fall and required intensive care between April 2012 and March 2014 at Okayama University Hospital, a tertiary care hospital in Okayama City:9 patients injured in 7 stepladder falls and 2 straight ladder falls. The median patient age was 69 years, and 8 were males. Six falls occurred in non-occupational settings. Head injuries predominated, and the injury severity score ranged from 2 to 35 (mean=21±12). At the time of discharge from the intensive care unit, one patient had died and 5 patients had some neurological disabilities. The case fatality rate was 11%. The total cost of care during the review period was ¥16,705,794, with a mean cost of ¥1,856,199 per patient. Ladder fall injuries are associated with a high rate of neurological sequelae and pose a financial burden on the health insurance system. A prevention education campaign targeting at older-aged males in non-occupational settings may be a worthwhile health service investment in this community.
Keywords accidental falls accident prevention hospital costs injuries ladder
Amo Type Original Article
Published Date 2015-10
Publication Title Acta Medica Okayama
Volume volume69
Issue issue5
Publisher Okayama University Medical School
Start Page 275
End Page 278
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2015 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 26490024
Web of Science KeyUT 000365519600003
JaLCDOI 10.18926/AMO/53557
FullText URL 69_4_213.pdf
Author Yumoto, Tetsuya| Sato, Keiji| Ugawa, Toyomu| Ichiba, Shingo| Ujike, Yoshihito|
Abstract Hyponatremia, a common electrolyte disorder associated with traumatic brain injuries (TBIs), has high mortality and morbidity rates. The aim of this study was to identify the risk factors for hyponatremia associated with TBI. We retrospectively analyzed the cases of TBI patients who were admitted to the emergency intensive care unit at Okayama University Hospital between October 2011 and September 2014. A total of 82 TBI patients were enrolled. The incidences of hyponatremia (serum sodium level of<135mEq/L) and severe hyponatremia (serum sodium level of<130mEq/L) within the first 14 days after admission were 51オ (n=42) and 20オ (n=16), respectively. After admission, hyponatremia took a median period of 7 days to develop and lasted for a median of 3 days. Multivariate analysis demonstrated that higher fluid intake from days 1 to 3 and the presence of cranial fractures were risk factors for hyponatremia. The 58 patients with hyponatremia experienced fewer ventilator-free days, longer intensive care unit stays, and less favorable outcomes compared to the 24 patients without hyponatremia;however, these differences were not significant. Further studies are needed to determine the optimal management strategy for TBI-associated hyponatremia in the intensive care unit setting.
Keywords traumatic brain injury hyponatremia cranial fracture fluid intake
Amo Type Original Article
Published Date 2015-08
Publication Title Acta Medica Okayama
Volume volume69
Issue issue4
Publisher Okayama University Medical School
Start Page 213
End Page 218
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2015 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 26289912
Web of Science KeyUT 000365519100004
JaLCDOI 10.18926/AMO/53021
FullText URL 68_6_323.pdf
Author Hirayama, Takahiro| Nagano, Osamu| Shiba, Naoki| Yumoto, Tetsuya| Sato, Keiji| Terado, Michihisa| Ugawa, Toyomu| Ichiba, Shingo| Ujike, Yoshihito|
Abstract In adult high-frequency oscillatory ventilation (HFOV), stroke volume (SV) and mean lung pressure (PLung) are important for lung protection. We measured the airway pressure at the Y-piece and the lung pressure during HFOV using a lung model and HFOV ventilators for adults (R100 and 3100B). The lung model was made of a 20-liter, airtight rigid plastic container (adiabatic compliance: 19.3ml/cmH<sub>2</sub>O) with or without a resistor (20cmH<sub>2</sub>O/l/sec). The ventilator settings were as follows: mean airway pressure (MAP), 30cmH2O;frequency, 5-15Hz (every 1Hz);airway pressure amplitude (AMP), maximum;and % of inspiratory time (IT), 50% for R100, 33% or 50% for 3100B. The measurements were also performed with an AMP of 2/3 or 1/3 maximum at 5, 10 and 15Hz. The PLung and the measured MAP were not consistently identical to the setting MAP in either ventilator, and decreasing IT decreased the PLung in 3100B. In conclusion, we must pay attention to the possible discrepancy between the PLung and the setting MAP during adult HFOV.
Keywords HFOV mean lung pressure mean airway pressure
Amo Type Original Article
Published Date 2014-12
Publication Title Acta Medica Okayama
Volume volume68
Issue issue6
Publisher Okayama University Medical School
Start Page 323
End Page 329
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 25519026
Web of Science KeyUT 000346882200002
Related Url http://ousar.lib.okayama-u.ac.jp/metadata/53132
JaLCDOI 10.18926/AMO/52897
FullText URL 68_5_285.pdf
Author Morisada, Sunao| Ugawa, Toyomu| Nosaka, Nobuyuki| Ujike, Yoshihito|
Abstract Current systems for the evaluation of trauma severity are tedious and difficult to apply in an actual emergency setting. We aimed to develop and assess the accuracy of a more efficient severity evaluation system, termed the Ugawa classification, using brain-type natriuretic peptide (BNP) measurement and the estimated glomerular filtration rate (eGFR). Two-hundred trauma patients were divided into 2 groups using an eGFR cut-off value of 90ml/min/1.73m2 as an indicator of normal renal function and 2 additional groups according to whether the BNP values were greater or less than the age in years. This resulted in 4 subject groups with different combinations of eGFR and BNP. The mean SOFA score, injury severity scores (ISS), trauma and injury severity scores (TRISS), and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of the groups were compared by Kruskal-Wallis test, and the mortality rate after 90 days was calculated. Significant intergroup differences were found in SOFA scores, ISS scores, and APACHE II-predicted mortality rates. Although no significant differences were found in the mortality rate after 90 days or TRISS-predicted mortality rate among the 4 groups, there was a trend toward increasing trauma severity from group 1 to 4. Thus, the Ugawa classification is as accurate as existing systems, has greater efficiency, and is user-friendly.
Keywords acute injury Acute Physiology and Chronic Health Evaluation II injury severity score sequential organ failure assessment trauma and injury severity score
Amo Type Original Article
Published Date 2014-10
Publication Title Acta Medica Okayama
Volume volume68
Issue issue5
Publisher Okayama University Medical School
Start Page 285
End Page 290
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 25338485
Web of Science KeyUT 000343269300005
Related Url http://ousar.lib.okayama-u.ac.jp/metadata/52958