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S Shimazaki

Publications and source records attributed to S Shimazaki.

At least 37 records · Page 2Linked to original sources
PubMed1998

Hyperechoic appearance of hepatic parenchyma on ultrasound examination of patients with blunt hepatic injury.

OBJECTIVE: To study the significance of a geographic hyperechoic liver parenchyma pattern on ultrasound (US) examination of patients with blunt abdominal injury. DESIGN: Prospective clinical study with double-blind evaluation of images and clinical data. METHODS AND MAIN RESULTS: We performed US examinations in 831 consecutive patients admitted to our hospital for blunt abdominal trauma and identified 33 with a geographic hyperechoic pattern in the liver. We correlated the appearance with computed tomographic images and with clinical, angiographic, and scintigraphic data. All patients with a geographic hyperechoic pattern showed mild computed tomographic evidence of hepatic injury (Mirvis grade 2, 69%; Mirvis grade 3, 31%). Excluding patients who required urgent surgery for other reasons and patients in shock, patients with the geographic hyperechoic pattern were managed conservatively with no complications. CONCLUSION: The geographic hyperechoic pattern of liver parenchyma on US examination of trauma patients is a mild injury that, of itself, does not require surgical therapy.

Adolescent↗
PubMed1998

[Analysis of transmission of Burkholderia cepacia isolates in an intrahospital by randomly amplified polymorphic DNA-PCR method].

Strains of Burkholderia cepacia isolated in our hospital from November 1995 to September 1996 were classified with randomly amplified polymorphic DNA-PCR (RAPD-PCR) and conventional biochemical tests (ID test.NF-18, API20NE, and Neg Combo 4J kit), and intrahospital isolates of B. cepacia were analysed. During the period 28 strains from inpatients and 2 from medical apparatus were isolated. Twenty four of 28 (85.7%) were from sputum. In 1996 from January to February, 20 strains were detected from 8 inpatients, and two strains were from the nebulizers at the Trauma and Critical Care Center (TCC). With typing of B. cepacia by conventional methods no epidemiological relations among isolates were found. However, DNA patterns of original isolates from the nebulizers at TCC by RAPD-PCR were identical with those of isolates in sputa from patients in other wards who had stayed at TCC, indicating that TCC was an initial source of transmission and the strain was transmitted with the patients to the wards. These results suggest that RAPD-PCR method might be a useful tool to analyse an epidemiological survey for intrahospital transmission of isolate.

Burkholderia Infections↗
PubMed1998

[Current treatment burn wounds: alternative wound coverage methods].

In patients with massive burn injuries and very limited skin donor sites, both acute-phase and long-term problems of skin loss must be solved by the use of alternative wound closure materials. Alternative materials can be used for either temporary wound coverage or for permanent wound closure. Recently, allogenic skin grafts have most commonly been used as alternative wound closure material. However, research is ongoing on many new materials to provide a readily available substitute for skin allografts for permanent wound closure. The best approach to the development of alternative permanent wound closure materials is to incorporate the host's own cellular and structural components. Four general strategies have been devised so far based on the type of matrix structure and cellular content: allografts; cultured epidermal grafts; dermal matrix grafts; and cultured-dermal matrix composite grafts. Several approaches using combined alternative wound closure materials have been used, including transplantation of artificial dermal matrix with thin epidermal autografts, and transplantation of artificial dermal matrix containing human fibroblasts. Ultimately, the best candidate materials for permanent wound closure after extensive burn injury must be determined in prospective, randomized, controlled clinical trials.

Burns↗
PubMed1997

Reduced resuscitation fluid volume for second-degree burns with delayed initiation of ascorbic acid therapy.

BACKGROUND: Oxygen radicals may play an important role in injury due to thermal burns. High-dose antioxidant ascorbic acid (vitamin C, Cenolete, Abbott Laboratory, Abbott Park, Ill) therapy reduces edema of burned and unburned tissue, lipid peroxidation, and subsequent resuscitation fluid volume requirement in experimental burn models. OBJECTIVE: To determine the hemodynamic effects of delayed initiation (2 hours after injury) of antioxidant therapy in patients with second-degree burns. DESIGN: Experimental study. MATERIALS AND INTERVENTION: Burns over 70% of body surface area were produced by subxiphoid immersion of 12 guinea pigs in 100 degrees C water for 3 seconds. The animals were resuscitated with Ringer's lactated solution according to the Parkland formula (4 mL/kg for 1% of burned body surface area during the first 24 hours) from 0.5 to 2 hours following injury, after which the resuscitation fluid volume was reduced to 25% of the Parkland formula. Animals received Ringer's lactated solution to which ascorbic acid (340 mg/kg during the first 24 hours) was added (vitamin C group [n = 6]) or Ringer's lactated solution only (control group [n = 6]). MEASUREMENTS: Heart rates, mean arterial blood pressure, cardiac output, hematocrit level, and water content in burned and unburned tissue were measured before injury and at intervals thereafter. RESULTS: There were no significant differences in heart rates (P = .29) and blood pressures (P = .53) between the 2 groups throughout the 24-hour study period. No animal died. The vitamin C group showed significantly lower hematocrit levels (P < .05) and significantly higher cardiac output values (P < .05) at 7 hours following burn injury and at intervals thereafter (P < .001). CONCLUSION: With delayed initiation of high-dose ascorbic acid therapy, the 24-hour fluid resuscitation volume was reduced to 32.5% of the Parkland formula, while maintaining adequate cardiac output values.

Animals↗
PubMed1997

Reduced resuscitation fluid volume for second-degree experimental burns with delayed initiation of vitamin C therapy (beginning 6 h after injury).

We studied the hemodynamic effects of delayed initiation (6 h postburn) of antioxidant therapy with high-dose vitamin C in second-degree thermal injuries. Seventy percent body surface area burns were produced by subxiphoid immersion of 12 guinea pigs into 100 degrees C water for 3 s. The animals were resuscitated with Ringer's lactate solution (R/L) according to the Parkland formula (4 ml/kg/% burn during the first 24 h) from 6 h postburn, after which the resuscitation fluid volume was reduced to 25% of the Parkland formula volume. Animals were divided into two groups. The vitamin C group (n = 6) received R/L to which vitamin C (340 mg/kg/24 h) was added after 6 h postburn. The control group (n = 6) received R/L only. Both groups received identical resuscitation volumes. Heart rates, mean arterial blood pressure, cardiac output, hematocrit level, and water content of burned and unburned tissue were measured before injury and at intervals thereafter. No animals died. There were no significant differences in heart rates or blood pressures between the two groups throughout the 24-h study period. The vitamin C group showed significantly (P < 0.05) lower hematocrits 8 and 24 h postburn, and higher cardiac outputs after 7 h postburn. At 24 h postburn, the burned skin in the vitamin C group had a significantly (P < 0.05) lower water content (73.1 +/- 1.1) than that of the control group (76.0 +/- 0.8). In conclusion, delayed initiation of high-dose vitamin C therapy beginning 6 h postburn with 25% of the Parkland formula volume significantly reduced edema formation in burned tissue, while maintaining stable hemodynamics.

Animals↗
PubMed1997

[Properties of extracellular products produced by group A streptococci isolated from patients with streptococcal toxic shock syndrome].

Extracellular products of group A streptococci isolated from patients with streptococcal toxic shock syndrome (STSS) were examined. The outline of the discussion of the 3 products are as follows; streptolysin O (SLO), proteinase and erythrogenic toxin. SLO and proteinase showed a relatively large amount of products more than erythrogenic toxin. SLO produced by group A streptococci isolated from the patient with STSS had an isoelectric point (pI) of 6.0 and a molecular weight of 64,000 and showed hemolytic activity in the presence of 2-mercaptoethanol (2-ME). Furthermore, the hemolytic activities of all components were inhibited by gamma-globulin and cholesterol. Proteinase had pIs of 8.7 and 8.9, and a molecular weight of 21,000. These data suggest that STSS clinical criteria probably reflects a characteristic of a large amount of products of individual S. pyogenes isolates.

Bacterial Proteins↗
PubMed1997

Nonsurgical management of patients with blunt hepatic injury: efficacy of transcatheter arterial embolization.

OBJECTIVE: We evaluated the efficacy of transcatheter arterial embolization (TAE) for patients with blunt hepatic injury. SUBJECTS AND METHODS: Of 372 patients with trauma, 60 had evidence on CT of hepatic injury (Mirvis classification). Six of the 60 patients required emergency laparotomy and were excluded. Of the 54 remaining patients, 28 were classified as having high-grade hepatic injury (Mirvis classification of 3 or 4). All 28 underwent arteriography, and TAE was performed in single or multiple hepatic arterial branches when extravasation was seen. Angiography was repeated and cholescintigraphy was performed on patients with continued bleeding or biloma. RESULTS: Injuries detected were grade 1 (n = 13), grade 2 (n = 13), grade 3 (n = 20), and grade 4 (n = 8). The injury was correlated with the degree of hemoperitoneum seen on CT. Patients with low-grade injuries (Mirvis classification of 1 or 2) were treated conservatively, and no deaths or liver-related morbidity occurred. Of the 28 patients with high-grade injury, 15 also had angiographic evidence of extravasation and underwent TAE. The average fluid resuscitation volume was significantly larger in this group than in the other 13 patients with high-grade injuries who did not undergo TAE. Embolization was successful in all 15 patients, and the shock index was significantly reduced after TAE. All patients survived, with follow-up at 1-8 months (2.5 +/- 1.8 months, mean +/- SD). CONCLUSION: TAE is an effective alternative to surgery for patients with high-grade liver injury.

Adolescent↗
PubMed1997

[Efficacy of rectal diazepam suppository in the prophylaxis of febrile seizures: comparison with rectal chloral hydrate suppository].

We evaluated the efficacy of diazepam and chloral hydrate given rectally for the prophylaxis of recurrence of febrile seizure. The dose were 0.4 mg/kg for diazepam and 250 mg (for children younger than 3 years old) or 500 mg (for over 3 years old) for chloral hydrate. Another dose was given after an interval of 8 hours if body temperature continued to exceed 38.0 degrees C. Among the 452 patients with febrile seizures who visited our hospital from Jan. 1993 to Jun. 1995, 113 were studied who had at least one febrile episode in the follow-up period that extended over 6 months. These patients were divided into two groups: Group D (72 patients given diazepam) and Group C (41 patients given chloral hydrate). In group D and C, the numbers of febrile episodes were 238 and 167, and those of recurrent seizures 8 (3.8%) and 29 (20.4%), respectively. The recurrences rate was significantly higher in the latter group (p < 0.005). There was no statistical difference as to the mean dosage of diazepam or chloral hydrate between the patients with and without recurrence. The numbers of patients with seizure recurrence were 8 (11.1%) in group D and 12 (29.3%) in group C, being significantly larger in the latter (p < 0.005). Diazepam produced more adverse effects than chloral hydrate did. Thus diazepam suppositories for the prevention of recurrence of febrile seizures were more effective than chloral hydrate suppositories.

Child↗
PubMed1996

Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolization.

OBJECTIVE: We evaluated the efficacy of nonsurgical management of patients with blunt splenic injury using detailed angiographic examinations and transcatheter arterial embolization. SUBJECTS AND METHODS: We prospectively studied 228 patients who had blunt abdominal injury and for whom CT was performed. When splenic injury was revealed by CT, angiography was performed in all patients except those requiring emergency surgery. Transcatheter arterial embolization was performed when patients had the following angiographic criteria: (1) extravasation of contrast material extending beyond or within the splenic parenchyma, (2) arterial disruption or major arteriovenous fistula, or (3) both. Splenic function was subsequently estimated by 99mTc-sulfur colloid scintigraphy and repeat angiography. RESULTS: Of 228 patients with blunt trauma, 31 patients had CT evidence of splenic injury. In three of these 31 patients, emergency laparotomy was performed before angiography because of an associated injury or unstable circulatory status. In 13 of the 28 remaining patients, transcatheter arterial embolization was not required as these patients did not meet the necessary criteria. They were treated with bed rest. Transcatheter arterial embolization was performed in the remaining 15 patients and was completely successful in 13. Because one of these 13 patients died of a brain contusion, follow-up angiography and scintigraphy were performed in the remaining 12 patients and showed preservation of splenic function. Nonsurgical treatment of splenic injury with angiography was successful in 93% of patients. CONCLUSION: Our success rate for nonsurgical management of patients with blunt splenic injury should encourage more extensive evaluation and use of angiography for splenic injury and the subsequent management of splenic injury without surgery.

Adolescent↗
PubMed1996

Hemostasis with endoscopic hemoclipping for severe gastrointestinal bleeding in critically ill patients.

OBJECTIVES: The fact that endoscopic hemostasis is difficult to achieve and that the rebleeding rate is high in critically ill patients with gastrointestinal bleeding has often been reported. The purpose of this study was to examine the efficacy of endoscopic hemoclipping for gastrointestinal bleeding from ulcers and gastrointestinal lesions associated with critical illnesses. METHODS: Critically ill patients who were treated in a university hospital were studied prospectively. For patients with predefined clinically significant gastrointestinal bleeding, an established protocol of endoscopic hemoclipping (including indications and procedures) was used. RESULTS: Ten of 885 patients were treated according to this protocol. All suffered circulatory collapse, and respiratory management required intubation. The initial rate of hemostasis was 100%, and no rebleeding was observed. The APACHE III scores at 24 h after hemostasis were reduced, relative to the time of bleeding (p < 0.01). CONCLUSION: Endoscopic hemoclipping is useful in achieving hemostasis in critically ill patients with severe gastrointestinal bleeding.

APACHE↗
PubMed1996

[A case report of surgical management of blunt ruptured right atrium with blunt ruptured liver].

This is a case report of a 23 year old female involved in a car accident that caused blunt trauma to the patient. First of all, she was found to have cardiac tamponade when the abdomen was explored to suture and to put the gaze compression on for hemostasis of the ruptured liver. Then, she was brought to our institution by the ambulance. Upon the exploration of the heart under standby of extracorporal circulation (ECC), small multiple lacerations were found at the junction of the right atrium and superior vena cava. These were sutured directly to close without ECC. On the 2nd postoperative day, she was bought to the OR again to removal of the gaze tamponade from the ruptured liver and to complete hemostasis. The patient was discarded 35 days after admission.

Accidents, Traffic↗
PubMed1996

[Free radicals and surgical stress].

Free radicals have at least one unpaired electron. Some of them have very high reactivity and harmful to cells and tissues. O2-. and HO. are generated during re-perfusion phase of shock. Both induce lipid peroxidation and this attack initiates auto-continuing injury of membrane lipid by lipid peroxide. This may result in damage of membrane function and permeability alteration. NO is an another type of free radical and huge amount of NO is generated by inducible NO synthase with variety of stimulation. NO decreases vascular tonus and may be related with hyperdynamic circulatory status in sepsis. NOx and ONOO- which are NO derivatives, deteriorate mitochondrial function. Free radicals are one of major agents which damages patients under surgical stress, however, they also have important rules in our defense system. In this sense, control rather than suppression may be important to ameliorate injury caused by surgical stress.

Free Radicals↗
PubMed1995

Effects of the antiprotease ulinastatin on mortality and oxidant injury in scalded rats.

BACKGROUND: Proteolysis and oxidant injury are important mechanisms of injury in thermal burns. The glycoprotein ulinastatin has antiprotease and free radical-scavenging properties and therefore could be useful in the treatment of these injuries. OBJECTIVE: To determine the free radical-scavenging effects of ulinastatin on rats with thermal injury. DESIGN: An experimental study. MATERIALS AND INTERVENTIONS: Sixteen rats with a 70% surface area immersion scald were treated intravenously for 3 hours; immediately after injury, the rats were treated with ulinastatin, 100,000 U/kg, in lactated Ringer's injection. Sixteen control rats were also scalded but were given only lactated Ringer's injection. Sixteen additional sham control rats were immersed in 37 degrees C water and given ulinastatin. MEASUREMENTS: Levels of malondialdehyde, superoxide dismutase, lactate, and pyruvate in skin, along with the water content of the skin, were measured before injury and at intervals thereafter in six rats from each group. RESULTS: The mortality rate was 50% at 72 hours and 90% at 14 days in scalded control rats, but it was 0% at 72 hours and 20% at 14 days in the treated rats (P < .01). Levels of malondialdehyde and superoxide dismutase in the skin and the lactate-pyruvate ratio all remained at the same values (as those before scalding) in treated rats but rose in the skin of scalded control rats (P < .05 for each). The water content of scalded skin gradually increased after injury in all groups, but at 3 hours, the scalded skin in treated rats contained less water than that in scalded control rats (P < .05). CONCLUSION: Ulinastatin may have a therapeutic role in treating thermal injuries.

Animals↗
PubMed1995

Left aortic arch with right descending aorta and right ligamentum arteriosum associated with d-TGA and large VSD: surgical treatment of a rare form of vascular ring.

A 1-month-old boy with respiratory distress underwent pulmonary artery banding after diagnosis of d-loop transposition of the great arteries and ventricular septal defect. Respiratory distress recurred after surgery. Angiography, esophagography, and magnetic resonance imaging showed left aortic arch, retroesophageal aorta, and right descending aorta. Surgery at 9 months of age showed a right-sided ligamentum arteriosum. Division of the ligamentum relieved the constriction of the esophagus and trachea caused by this rare form of vascular ring.

Aorta, Thoracic↗
PubMed1995

Early diagnosis of small intestine rupture from blunt abdominal trauma using computed tomography: significance of the streaky density within the mesentery.

Enhanced computed tomography (CT) was done in 430 patients within 3 hours after blunt abdominal trauma. Thirteen patients were found to have ruptures of the small intestine. Nine of them had "the streaky density within the mesentery" and the position was identified by tracing the alimentary tract on each CT slice. The sensitivity and specificity of this sign was 69 and 100% respectively. The sensitivity for diagnosis of small intestinal rupture by the presence of this sign and/or free air was 85%. This was significantly higher than that of free air alone (p < 0.05). Eight patients had a rupture on a mesenteric site. Histopathological findings of the area with this sign included bleeding and cellular infiltration along the mesenteric vasculature. This appearance may be related to direct injury and chemical irritation of the mesentery caused by intestinal rupture. The streaky density appears to be a significant finding for small intestinal rupture.

Abdominal Injuries↗
PubMed1995

Immunocytochemical detection of tumor necrosis factor-alpha in infiltrating tumor cells in the cerebrospinal fluid from five patients with leptomeningeal carcinomatosis.

We studied the immunoreactivity for tumor necrosis factor-alpha (TNF-alpha) in cerebrospinal fluid (CSF) cell smears from five patients with leptomeningeal carcinomatosis (LC). Immunostained TNF-alpha-positive tumor cells had brownish deposits in the cytoplasm, but no deposits were observed in the nucleus. The intensity of the TNF-alpha staining was greater in these tumor cells than in macrophages from patients with inflammatory diseases. Approximately 27-72% of the tumor cells were found to be TNF-alpha immunoreactive in all five samples from the patient with LC. These results suggest that the large amount of TNF-alpha produced by infiltrating tumor cells may play an important role in the development of the tumor.

Adenocarcinoma↗
PubMed1995

Effect of mild hypothermia on the coefficient of oxygen delivery in hypoxemic dogs.

Hypothermia is one of therapeutic options in patients with severe acute respiratory failure. This study was designed to determine the optimum core temperature during hypoxemia by analyzing oxygen delivery (DO2) and consumption (VO2). Six dogs were ventilated using a mixed gas of N2 and air (fractional concn of O2 in inspired gas = 0.12) with total muscle relaxation under general anesthesia. Hypoxia (arterial PO2 approximately 35 Torr) was maintained during the experimental period. The core temperature was reduced progressively from 37 to 30 degrees C by surface cooling. The coefficient of oxygen delivery was defined as DO2 divided by VO2. In each animal, the DO2/VO2 was calculated by altering the core temperature by 1 degrees C, and its relative value was a third-order polynomial function of core temperature having a maximum value at a core temperature of 32.1 +/- 0.46 degrees C. At a core temperature of 32 degrees C, the blood lactate level was significantly lower than that at a core temperature of 37 degrees C (6.3 +/- 1.3 vs. 12.2 +/- 1.6 mg/dl; P < 0.05). The relative value of the DO2/VO2 was highest with limited lactate elevation at a core temperature approximately 32 degrees C. Under the condition of hypoxia, mild hypothermia approximately 32 degrees C may be optimal to improve oxygen demand-supply balance.

Animals↗