Acute Medicine & Surgery最新文献

{"title":"CT radiation exposure and management of delayed pseudoaneurysms in pediatric liver and spleen injuries: A multicenter study","authors":"Atsushi Tanikawa,&nbsp;Daisuke Kudo,&nbsp;Hiroyuki Ohbe,&nbsp;Morihiro Katsura,&nbsp;Katsunori Ono,&nbsp;Yohei Inaba,&nbsp;Shigeki Kushimoto","doi":"10.1002/ams2.70089","DOIUrl":"https://doi.org/10.1002/ams2.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Minimizing radiation exposure and preventing pseudoaneurysm rupture are crucial for pediatric patients with delayed pseudoaneurysm following blunt liver and/or spleen injuries. However, the radiation exposure from follow-up CT scans in patients managed conservatively or with prophylactic embolization remains unclear. This study aimed to evaluate radiation exposure from CT scans based on these management strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This research was a secondary analysis of a multicenter, retrospective observational study that included pediatric patients (≤16 years old) who sustained blunt liver and/or spleen injuries at 83 institutions in Japan from 2008 to 2019. Patients diagnosed with delayed pseudoaneurysm, defined as a newly detected pseudoaneurysm on or after the second day post-injury, were included. This descriptive study compared CT-related radiation exposure and rupture rates between patients with and without prophylactic embolization, with radiation exposure assessed using dose length product.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty patients had delayed pseudoaneurysm. Of these, 28 (56%) did not receive prophylactic embolization. The sum of dose length product in patients with delayed pseudoaneurysm not receiving prophylactic embolization was 4203 (1802–7503) mGy·cm, compared with 2492 (1258–4457) mGy·cm in those receiving prophylactic embolization (<i>p</i> = 0.12). Then, pseudoaneurysm rupture occurred in 32% of no prophylactic embolization patients, whereas no ruptures were observed in the embolization group (<i>p</i> = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pediatric patients not receiving prophylactic embolization trended to have high radiation exposure from CT scans and had a higher rate of ruptured delayed pseudoaneurysm compared to those receiving embolization. These findings support further study of strategies to reduce rupture risk and radiation exposure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Japanese Society for Burn Injuries Burn Registry 2011","authors":"Yoshiaki Inoue,&nbsp;Miyuki Kishibe,&nbsp;Misato Kuroyanagi,&nbsp;Yukio Sato,&nbsp;Mitsuru Nemoto,&nbsp;Minoru Hayashi,&nbsp;Tomoya Hirose,&nbsp;Asako Matsushima,&nbsp;Naoki Morita,&nbsp;Yuya Yoshimura,&nbsp;Junichi Sasaki","doi":"10.1002/ams2.70088","DOIUrl":"https://doi.org/10.1002/ams2.70088","url":null,"abstract":"<p>In April 2011, the Japanese Society for Burn Injuries (JSBI) Burn Registry 2011 was launched to develop guidelines and enhance the quality of burn care in the country. By the end of March 2022, there were 120 facilities involved, and the total number of registrations exceeded 20,000. The registry was established as a web-based database, and its scope included requests for data entry from each registered facility. The survey covered both acute treatment and reconstructive surgery in the chronic phase. In this research, we reported the current status of burn care in Japan, based on the JSBI burn registry 2011 data from April 2011 to March 2021. Our data might reflect the currently provided quality by major medical institutions in Japan. However, after 11 years of functioning, this registry was supposed to have become inadequately informative because of the changes in treatment and the revised JSBI clinical practice guidelines for the management of burn care. Since April 2023, the contents and system of the JSBI burn registry 2023 have been completely revised. Nevertheless, we hope that the results of this analysis can be applied by future generations to further improve burn care.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remifentanil use in intensive care units: Current evidence and future perspectives","authors":"Hiromu Okano,&nbsp;Hiroshi Okamoto,&nbsp;Masaaki Sakuraya,&nbsp;Yoshitaka Aoki","doi":"10.1002/ams2.70087","DOIUrl":"https://doi.org/10.1002/ams2.70087","url":null,"abstract":"<p>Pain management in intensive care units (ICUs) is crucial for improving patient outcomes. Remifentanil, an ultra-short-acting opioid, is metabolized independently of renal and hepatic function, making it an attractive analgesic. This article discusses the pharmacological effects of remifentanil, its usage, and potential side effects in the ICU, current evidence, and clinical situations where its use is preferred. Currently, patients for whom remifentanil use might be considered include (1) post-cardiac surgery patients, (2) patients requiring frequent neurological assessments, (3) patients with hepatic or renal failure, and (4) patients with acute respiratory distress syndrome who are at high risk of self-inflicted lung injury. In these patient groups, remifentanil's unique properties may contribute to effective pain management. However, data on its long-term use in ICUs remains limited. To establish appropriate usage, further research is needed, particularly on withdrawal symptoms, opioid-induced hyperalgesia, and optimal transition strategies following prolonged administration. Furthermore, cost-effectiveness analyses are essential to assess its economic feasibility in ICU settings.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144923815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased incidence of secondary postpartum hemorrhage due to subinvolution of the placental site and effectiveness of interventional radiology","authors":"Chikao Ito,&nbsp;Chihiro Koga,&nbsp;Wataru Yamashita,&nbsp;Yusuke Kawasaki,&nbsp;Yasutaka Yoshiike,&nbsp;Isao Takahashi,&nbsp;Kosuke Kobayashi,&nbsp;Jun Isogai","doi":"10.1002/ams2.70085","DOIUrl":"https://doi.org/10.1002/ams2.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Secondary postpartum hemorrhage (PPH), which occurs between 24 h and 12 weeks postpartum, is a rare but potentially severe complication. The primary causes include retained products of conception (RPOC), subinvolution of the placental site (SIPS), and endometritis. SIPS, historically diagnosed histopathologically, is increasingly being identified using ultrasonography and angiography. However, this condition remains underrecognized in Japan. Uterine artery embolization (UAE) is an effective and minimally invasive treatment for PPH. This study aimed to evaluate the increasing incidence of secondary PPH, particularly due to SIPS, and the effectiveness of UAE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective review, we analyzed cases of PPH requiring blood transfusion or embolization at a regional perinatal medical center between December 2014 and November 2024. Patients with placenta previa or accreta were excluded. Maternal characteristics, use of assisted reproductive technology, delivery mode, bleeding onset, hemostatic intervention, and transfusion status were evaluated. Imaging diagnoses were confirmed by radiologists and interventional radiology-certified emergency physicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 8107 deliveries, 37 cases (0.46%) of PPH were identified. 10 patients had secondary PPH. UAE was performed in 9 of the 10 cases (90%), with a 100% success rate. SIPS was the most common cause of secondary PPH (70%). Major complications were not observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The incidence of secondary PPH, particularly due to SIPS, has been increasing. UAE is considered a safe and effective intervention. Strategies for improved recognition and further research on PPH are needed to optimize the diagnosis and management of PPH due to SIPS in Japan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of paroxysmal sympathetic hyperactivity following cerebral infarction due to basilar artery dissection","authors":"Erina Yoritsune,&nbsp;Akira Sugie,&nbsp;Hitoshi Kobata","doi":"10.1002/ams2.70086","DOIUrl":"https://doi.org/10.1002/ams2.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Paroxysmal sympathetic hyperactivity (PSH) is a syndrome characterized by episodic tachycardia, tachypnea, hypertension, fever, sweating, pupillary dilatation, and dystonic postures. Traumatic brain injury is the leading cause of PSH; however, its occurrence following basilar artery (BA) dissection has not been reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A previously healthy 23-year-old man was found unresponsive and was transported with a Glasgow Coma Scale score of 11. Imaging studies revealed an acute ischemic stroke attributable to BA dissection. Magnetic resonance imaging showed progressive lesions involving the bilateral thalami, occipital lobes, cerebellar hemispheres, vermis, midbrain, pons, and periaqueductal gray. On the 8th day after admission, he developed PSH symptoms, which subsided after medical treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A case of PSH following BA dissociation is reported. The ischemic lesions presented here indicate the essential anatomical location causing PSH. Early treatment is warranted, recognizing that PSH could be an adverse event following BA dissection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive effects of the lactate/albumin ratio on neurological outcomes in patients after out-of-hospital cardiac arrest","authors":"Koki Nakada,&nbsp;Yuki Miyamoto,&nbsp;Toshinari Kawama,&nbsp;Toshihiro Hatakeyama,&nbsp;Tetsuhisa Kitamura,&nbsp;Bon Ohta,&nbsp;Tasuku Matsuyama","doi":"10.1002/ams2.70082","DOIUrl":"https://doi.org/10.1002/ams2.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Predicting outcomes for out-of-hospital cardiac arrest (OHCA) patients remains challenging. We aimed to evaluate the association between the lactate/albumin ratio (LAR) upon hospital arrival and neurological outcomes in OHCA patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicenter, retrospective, nationwide observational study was based on data from the JAAM-OHCA registry, including 28,098 adults with non-traumatic OHCA from 140 emergency medical centers across Japan (June 2014 to December 2021). Receiver-operating characteristic curves assessed the predictive ability of LAR, lactate, and albumin levels. A reference model based on age, sex, witnessed arrest, initial cardiac rhythm, and time from call to hospital arrival was compared with models including LAR, lactate, or albumin levels. The primary outcome was a favorable neurological outcome at 30 days, with a secondary outcome at 90 days. Subgroup analyses were conducted among admitted patients and those who received active post-resuscitation treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 28,098 patients, 1421 (5.1%) achieved favorable neurological outcomes at 30 days. We demonstrated that LAR had a significantly higher area under the curve than either lactate or albumin for predicting both 30- and 90-day outcomes (all <i>p</i> &lt; 0.001), and better predictive value than either marker when added to the reference model. However, in the subgroup analysis of admitted patients, the statistical difference between LAR and albumin was no longer apparent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The lower LAR upon hospital arrival was independently associated with a favorable neurological outcome in OHCA patients. However, its utility may vary depending on patient background, and further studies are needed to establish its clinical relevance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A machine learning model for predicting short-term outcomes after rapid response system activation","authors":"Takaki Naito,&nbsp;Micheal Li,&nbsp;Shigeki Fujitani","doi":"10.1002/ams2.70083","DOIUrl":"https://doi.org/10.1002/ams2.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Maintaining rapid response team (RRT) response quality is difficult. A system that supports RRT assessment could potentially contribute to medical safety. Although rapid response system (RRS) triggers have been well-studied, studies on the prediction models of short-term prognosis after RRS activation are scarce. We aimed to develop a model to predict short-term outcomes after RRS activation using machine learning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study used the In-Hospital Emergency Registry in Japan, a multicentre RRS online registry. We collected data on patient demographics, treatment before RRS, RRT calls, and physiological parameters. The outcome was death within 24 h after RRS calls or unplanned transfers to an intensive care unit. To develop the eXtreme Gradient Boosted Tree Classifier (XGB) and Random Forest (RF) algorithms, a logistic regression (LR) algorithm was used. For model comparison, receiver-operating area under the curve (AUC) was evaluated and compared with those of the National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>5414 cases were included in the study. The outcome occurred in 28.4% of the cases. The XGB model showed the highest AUC (0.798) compared to the RF model (0.796), LR model (0.785), NEWS (0.696), and MEWS (0.660). The most weighted feature in the XGB model was doctor activation, followed by hypotension as the activation criteria and usage of oxygen.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We developed the first machine learning model for short-term prognosis after RRS. This model has the potential to support decision-making by RRT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144815035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repositioning POCUS in the diagnostic landscape of gastric anisakiasis: A call toward pragmatic integration","authors":"Nathkapach Kaewpitoon Rattanapitoon,&nbsp;Patpicha Arunsan,&nbsp;Nav La,&nbsp;Schawanya Kaewpitoon Rattanapitoon","doi":"10.1002/ams2.70084","DOIUrl":"https://doi.org/10.1002/ams2.70084","url":null,"abstract":"&lt;p&gt;The recently published case report by Kitai et al. brings forward a timely and clinically impactful discussion on the role of point-of-care ultrasound (POCUS) in the early diagnosis of gastric anisakiasis&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;—a parasitic disease whose clinical patterns and geographical distribution are being reshaped by global dietary trends and food distribution networks.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The authors are to be commended for the clarity of their diagnostic approach. The combination of symptom chronology, dietary history, and real-time POCUS allowed for immediate endoscopic referral. The ultrasonographic finding of gastric wall thickening, though non-specific, provided critical support in narrowing down the differential diagnosis in a patient with acute epigastric pain.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; This case not only illustrates the diagnostic agility of POCUS but also challenges conventional reliance on CT in early anisakiasis management.&lt;/p&gt;&lt;p&gt;While POCUS is more commonly applied to hepatobiliary or intestinal emergencies,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; its role in gastric parasitic infections remains underexplored. Previous reviews on intestinal anisakiasis have emphasized submucosal edema, ascites, and segmental ileal wall thickening as typical sonographic features.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; However, sonographic patterns specific to gastric anisakiasis remain largely anecdotal. The current report thus adds a valuable datapoint to the limited body of literature.&lt;/p&gt;&lt;p&gt;We propose two directions for expanding the utility of POCUS in this context. First, a multicentric image repository could aid in recognizing consistent gastric findings in anisakiasis—be it focal mucosal swelling, peristaltic arrest, or even visualization of the larval body, as sporadically reported in intestinal cases.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Second, pretest probability stratification using clinical scoring systems (e.g., raw seafood consumption, timing of pain onset, absence of fever) could guide clinicians on when POCUS might be most effective or when CT should be prioritized.&lt;/p&gt;&lt;p&gt;Notably, the diagnostic success in this case was likely supported by the operator's advanced ultrasound experience (14 years). This emphasizes the need to include GI parasitology scenarios in emergency ultrasound training—a currently underrepresented domain. Embedding such cases in simulation-based curricula could build operator confidence in less common applications of POCUS.&lt;/p&gt;&lt;p&gt;In summary, this case invites emergency physicians and acute care teams to rethink the scope of POCUS—not merely as a triage tool, but as a frontline diagnostic modality for select gastrointestinal infections. Future efforts should aim at building evidence-based protocols for its judicious use in anisakiasis-endemic areas.&lt;/p&gt;&lt;p&gt;The authors declared that this study received no financial support.&lt;/p&gt;&lt;p&gt;The authors declare no competing interests.&lt;/p&gt;&lt;p&gt;Approval of the research protocol: NA.&lt;/p&gt;&lt;p&gt;Informed","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of glyphosate poisoning with falsely elevated creatinine levels measured by dry chemistry methods","authors":"Kento Hojo,&nbsp;Tomohiro Abe,&nbsp;Saki Tanaka,&nbsp;Kengo Hatanaka,&nbsp;Hidenobu Ochiai","doi":"10.1002/ams2.70079","DOIUrl":"https://doi.org/10.1002/ams2.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The ingestion of glyphosate herbicides can cause severe acute kidney injury. We present a case of glyphosate poisoning in which creatinine levels were falsely elevated when measured using a dry chemistry analyzer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>An 83-year-old man ingested glyphosate herbicide during a suicide attempt and presented with gastrointestinal symptoms. A dry chemistry analyzer showed high creatinine levels (10.62 mg/dL); thus, the patient was transported to our hospital for renal replacement therapy. However, enzymatic testing showed a lower creatinine level (1.36 mg/dL). Further investigation comparing creatinine measurements revealed a high creatinine level only through the dry chemistry method, despite the relatively low glyphosate concentration (55 mg/L).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The dry chemistry method falsely shows an elevated creatinine value, which may affect clinical decisions regarding the management of patients with glyphosate poisoning. Careful interpretation of creatinine measurements using the dry chemistry method is important in glyphosate poisoning cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144758664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fulminant myocarditis in immune-mediated thrombotic thrombocytopenic purpura: A case report","authors":"Haruka Ishikita,&nbsp;Akira Endo,&nbsp;Keisuke Suzuki,&nbsp;Tomohiro Akutsu,&nbsp;Yuichi Araki,&nbsp;Koji Morishita","doi":"10.1002/ams2.70075","DOIUrl":"https://doi.org/10.1002/ams2.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Thrombotic thrombocytopenic purpura is a life-threatening thrombotic microangiopathy characterized by systemic microvascular thrombosis. Cardiovascular complications, including myocardial ischemia and necrosis, are a leading cause of acute mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 54-year-old man was diagnosed with immune-mediated thrombotic thrombocytopenic purpura. On Day 2, he developed sudden cardiac arrest, requiring venoarterial extracorporeal membrane oxygenation for circulatory support. Echocardiography revealed diffuse severe hypokinesis, ventricular hypertrophy, and pericardial effusion. Myocardial biopsy performed on Day 3 showed no findings of microthrombi or necrosis. These findings suggested fulminant myocarditis rather than myocardial ischemia. The patient was successfully treated with multidisciplinary treatment including plasma exchange, achieving full recovery by Day 44.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case highlights fulminant myocarditis as a complication of immune-mediated thrombotic thrombocytopenic purpura. As myocarditis is potentially reversible, providing appropriate supportive therapy may contribute to an improved prognosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}