Acute Medicine & Surgery最新文献

{"title":"A case report: Efficacy of thoracic MRA for ischemic stroke due to acute aortic dissection","authors":"Jun Nagayama,&nbsp;Kenji Fujizuka,&nbsp;Shioya Hayato,&nbsp;Ryosuke Tsuchiya,&nbsp;Mitsunobu Nakamura","doi":"10.1002/ams2.70066","DOIUrl":"https://doi.org/10.1002/ams2.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ischemic stroke requires prompt diagnosis and treatment but rarely results from acute aortic dissection. The administration of tissue-type plasminogen activator (t-PA) to such patients can lead to serious complications and potentially fatal outcomes. Here, we report a case in which thoracic magnetic resonance angiography (MRA) was useful for identifying cerebral infarction complicated by acute aortic dissection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 60-year-old man presented with a sudden onset of left-sided hemiplegia, right-sided hemiparesis, and dysarthria. Noncontrast CT ruled out intracranial hemorrhage; however, aortic dissection was not detected. MRI showed reduced blood flow in the right middle cerebral artery, and t-PA administration was suspected to have caused ischemic stroke. However, thoracic MRA revealed dissection from the ascending aorta to the arch, which was diagnosed using contrast-enhanced CT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Thoracic MRA is useful for diagnosing acute aortic dissection in patients with a stroke.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085249","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":"Letter to ‘Automated CT image prescription of the gallbladder using deep learning: Development, evaluation, and health promotion’","authors":"Hinpetch Daungsupawong,&nbsp;Viroj Wiwanitkit","doi":"10.1002/ams2.70065","DOIUrl":"https://doi.org/10.1002/ams2.70065","url":null,"abstract":"<p>We would like to comment on “Automated CT image prescription of the gallbladder using deep learning: Development, evaluation, and health promotion.<span>¹</span>” This study created an automatic detection system for acute cholecystitis (AC) that can recognize gallbladders from CT scans of patients and controls. It detected gallbladders using the VGG-16 architecture and processed them using techniques such as the Flood fill algorithm and centroid calculation, as well as U-Net for picture segmentation and feature extraction. The combination of results from many models aided in the development of an automatic and accurate AC detection system.</p><p>However, using the accuracy value to evaluate the system's performance may not be sufficient to reflect the ability to distinguish between cases with different conditions, especially when there is an imbalance of data, such as the difference between AC patients and non-patient controls, or when the data is not evenly distributed, which may cause the accuracy value to not reflect the model's effectiveness in handling more difficult cases. Other indices, such as sensitivity, specificity, and AUC (Area Under Curve) values, can help increase the accuracy of model performance evaluation. The example of this kind of study is the previous publication by Ma et al.<span>²</span></p><p>Furthermore, it should be considered to develop techniques that improve processing in cases with low-quality or noisy images, which may cause the model to misclassify or skip over complex cases. This includes the use of diverse data from various sources, such as adding images from patients with complications or changes in gallbladder characteristics.</p><p>Approaches that can learn from various data and adapt to the diversity of CT scans, as well as deep learning approaches, should be applied in future development. Further investigation into the model's capacity to process under multiple scenarios, such as changing operational conditions or patient diversity, will improve the system's robustness and accuracy in practice. This study describes the development of an AI-based AC detection system that can work quickly and accurately; however, further developments in low-quality image processing and the use of more diverse statistical techniques are required to enable this technology to detect the disease more accurately and efficiently in clinical practice.</p><p>The authors declare no conflicts of interest.</p><p>Approval of the research protocol: Not applicable, there is no involvement of humans or animals.</p><p>Informed consent: Not applicable, there is no human subject.</p><p>Registry and the registration no. of the study/trial: NA.</p><p>Animal studies: NA.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944949","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":"Incidence and risk stratification of caller noncompliance with dispatcher instructions for cardiopulmonary resuscitation","authors":"Keita Shibahashi,&nbsp;Norikazu Nonoguchi,&nbsp;Ken Inoue,&nbsp;Taichi Kato,&nbsp;Kazuhiro Sugiyama","doi":"10.1002/ams2.70057","DOIUrl":"https://doi.org/10.1002/ams2.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to describe the incidence of, identify risk factors for, and develop a simple risk-scoring model for cases where callers fail to follow dispatcher instructions regarding cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Tokyo Fire Department's database, cases of out-of-hospital cardiac arrest in adults where callers received dispatcher instructions regarding CPR between 1 January 2018 and 31 December 2022 were identified. Factors associated with noncompliance with CPR instructions were determined using multivariable logistic regression analysis. A simple scoring model was developed to stratify the caller noncompliance probability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 19,525 cases were included. Bystander CPR was not provided in 11,443 (58.6%) of these cases; the 1-month favorable neurological outcome rate was significantly lower in this group (1.1% vs. 2.2%, <i>p</i> &lt; 0.001). Regression analysis revealed that patient age, male patient sex, emergency call at night, cardiac arrest in the bathroom, and a familial relationship between the caller and the patient were significantly associated with noncompliance. The scoring model assigned 1 point for each of the following criteria: patient aged ≥65 years, familial relationship between the caller and the patient, and cardiac arrest in the bathroom. It also stratified caller noncompliance probability, with scores of 0, 1, 2, and 3 corresponding to probabilities of 48.0%, 50.8%, 61.3%, and 70.5%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found that callers frequently did not follow dispatcher CPR instructions and identified risk factors for caller noncompliance. Furthermore, the simple scoring model developed effectively stratified the probability of caller noncompliance associated with dispatcher instructions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944948","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":"Outcomes of blunt trauma patients in police versus ground ambulance transport across US trauma centers","authors":"Romy Rahhal,&nbsp;Paul Sakr,&nbsp;Rana Bachir,&nbsp;Mazen El Sayed","doi":"10.1002/ams2.70061","DOIUrl":"https://doi.org/10.1002/ams2.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Blunt injuries constitute a major cause of death in the United States. Regionalization in trauma systems improves patients' survival and outcomes. Limited data exist on the impact of mode of transport in regionalized trauma systems. This study examines the association between trauma designation levels and survival to hospital discharge of patients with blunt trauma transported by police or ground ambulance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective-matched cohort study used the 2017 National Trauma Data Bank dataset. Adult blunt trauma patients transported by police were identified and matched (one-to-four) to those transported by ground ambulance. Demographic characteristics, injury, and clinical data were described and compared according to trauma designation levels. The survival rate was determined by the transport mode and/or the trauma designation levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 5316 blunt trauma patients were included. Mean age was 41.8 (±16.5) years, and most were males (81.8%). Most patients were transported to Level I centers and were more likely to be admitted (91.1%) compared to those transported to level II and level III trauma centers (87.5%). They also had a lower survival rate compared with the latter group ((98.7%) vs. (99.7%), <i>p</i> = 0.001). Survival rates were similar when comparing patients by mode of transport (<i>p</i> = 0.785). This remained unchanged after stratifying by the trauma designation levels (<i>p</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adult patients with blunt trauma transported by police or ground ambulance had similar survival across different trauma level centers. Increased police involvement in the transport of blunt trauma patients is recommended.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926152","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":"Beyond respiratory distress: The impact of H1N1 influenza on circulatory failure","authors":"Kei Kimoto,&nbsp;Yudai Iwasaki,&nbsp;Yoshihiro Hagiwara,&nbsp;Takayuki Ogura","doi":"10.1002/ams2.70062","DOIUrl":"https://doi.org/10.1002/ams2.70062","url":null,"abstract":"&lt;p&gt;We are writing to discuss the occasionally severe clinical course of patients infected with the H1N1 influenza virus, which can cause respiratory failure and severe acute respiratory distress syndrome (ARDS), requiring venovenous extracorporeal membrane oxygenation (ECMO).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; However, it can also result in severe cardiovascular complications like fulminant myocarditis and secondary circulatory failure. We encountered two cases requiring venoarterial ECMO due to secondary cardiovascular complications. Informed consent was obtained from the patients' families.&lt;/p&gt;&lt;p&gt;A 74-year-old woman with diabetes and valvular heart disease presented in early December 2024 with fever, followed by chest pain. She was diagnosed with influenza A (H1N1) pdm09 and type 2 myocardial infarction due to an ischemic supply–demand mismatch triggered by influenza infection. On admission, her Glasgow Coma Scale (GCS) score was E3V4M6, temperature 37.9°C, heart rate 117 beats/min, blood pressure 121/72 mmHg, respiratory rate 24 breaths/min, and oxygen saturation (SpO&lt;sub&gt;2&lt;/sub&gt;) 93% on 6 L of oxygen. She reported moderate chest pain, with no other significant abnormalities. Electrocardiography showed extensive ischemic patterns, and echocardiography revealed mild wall motion abnormalities in the anterior septum and apex. Antiviral therapy was initiated, and percutaneous coronary intervention (PCI) was planned. On Day 2, she developed ventricular fibrillation and underwent emergency extracorporeal cardiopulmonary resuscitation. PCI for triple vessel disease improved circulation, but worsening respiratory status necessitated venovenous ECMO. However, her respiratory condition did not improve due to secondary bacterial pneumonia, making ECMO weaning difficult. Despite prolonged ECMO support, she passed away on Day 53.&lt;/p&gt;&lt;p&gt;A 49-year-old woman with no significant medical history experienced fever and dyspnea 3 days before admission. Symptoms worsened on the admission day, leading to severe mobility difficulties and an emergency call. On admission, GCS score was E1V1M4, temperature 39.0°C, heart rate 180 beats/min (atrial fibrillation), blood pressure 100/70 mmHg, respiratory rate 32 breaths/min, and SpO&lt;sub&gt;2&lt;/sub&gt; 90% on 10 L of oxygen. Tests showed severe metabolic acidosis (pH, 7.19; base excess, −1.7 mmol/L), elevated thyroid stimulating hormone levels (&lt;0.01 μIU/mL), free triiodothyronine (16.2 pg/mL), and free thyroxine (5.28 ng/dL). Echocardiography showed diffuse severe wall motion abnormalities with a left ventricular ejection fraction of 10%. The patient was diagnosed with acute heart failure (AHF) due to thyroid storm triggered by influenza A (H1N1) pdm09 infection, and venoarterial ECMO was initiated for circulatory failure. Treatments included antivirals, methimazole, and potassium iodide. On Day 2, diuresis improved and cardiac function gradually recovered. The patient was successfully weaned from VA-ECMO on Day 7 and subsequently discha","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896893","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":"Hemostatic technique using cyanoacrylate for fingertip cut injury: A review of 21 cases","authors":"Shingo Sasamatsu,&nbsp;Takeshi Ueda","doi":"10.1002/ams2.70056","DOIUrl":"https://doi.org/10.1002/ams2.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>In the emergency department, fingertip cut injuries often involve skin loss and bleeding. Traditional hemostatic methods, such as applying simple pressure or using pressure combined with alginate fibers, are sometimes insufficient and require sutures or cauterization. To address these challenges, we explored the use of cyanoacrylate for hemostasis in fingertip cut injuries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively collected data from patients aged ≥ 20 years who presented to our emergency department for fingertip cut injuries between April 2023 and March 2024. Injuries were characterized by skin loss without contamination, bone exposure, or fractures. We suggest the cyanoacrylate sealing method (CASM) in most cases. CASM involved wound cleansing, a proximal tourniquet with a rubber band, a thin cyanoacrylate coating on the wound, and observation for rebleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 21 patients (mean age: 46.4 years) underwent CASM, achieving successful hemostasis in all cases. Compression hemostasis was attempted in 12 patients before CASM; however, no hemostasis was achieved. Five patients reported a tolerable stinging sensation at the wound site. The cyanoacrylate coating detached naturally within 4 to10 days, and complete epithelialization was achieved within 14 days. No significant complications, such as infection or delayed wound healing, were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CASM is a simple and minimally invasive method to achieve hemostasis in fingertip cut injuries. It significantly reduces the procedure time compared with traditional methods such as suturing or cauterization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143883983","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":"Response to “Letter to Early do-not-attempt resuscitation orders and neurological outcomes in older out-of-hospital cardiac arrest patient”","authors":"Megumi Kohri,&nbsp;Shinnosuke Kitano,&nbsp;Takashi Tagami","doi":"10.1002/ams2.70055","DOIUrl":"https://doi.org/10.1002/ams2.70055","url":null,"abstract":"&lt;p&gt;We thank Dr. Tangkamolsuk and colleagues for their insightful comments and interest in our recent article, “Early do-not-attempt resuscitation orders and neurological outcomes in older out-of-hospital cardiac arrest patient: A multicenter observational study.”&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; We appreciate the opportunity to clarify several important points raised.&lt;/p&gt;&lt;p&gt;First, Tangkamolsuk et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; highlighted the absence of a comprehensive assessment of patient symptoms or pain management associated with Do Not Attempt Resuscitation (DNAR) decision-making. We acknowledge this limitation. However, it is crucial to emphasize that our study exclusively included patients who had achieved the return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest (OHCA), meaning our entire cohort presented with comatose post-cardiac arrest syndrome. Nearly all these patients were unconscious, mechanically ventilated, and incapable of personally communicating their preferences regarding DNAR orders. In the field of emergency and critical care, it has been reported that DNAR orders are often decided not by the patients themselves but by their families or medical professionals.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Furthermore, patients who already had explicit DNAR orders prior to hospital admission were excluded from the analyses.&lt;/p&gt;&lt;p&gt;In this clinical context, pain and symptom management is routinely and rigorously provided using sedation and analgesia protocols as part of standardized intensive care practices. Given these standard protocols and patient conditions, we believe variability in pain management or subjective symptom assessment is unlikely to have significantly influenced DNAR decision-making in our cohort. Nevertheless, as the authors appropriately suggest, prospective studies specifically exploring these dimensions in DNAR decisions would be valuable.&lt;/p&gt;&lt;p&gt;Second, we appreciate the authors' comment regarding the potential effects of institutional policies and clinicians' personal judgments or biases. To minimize such confounding, our analysis employed propensity score analysis with inverse probability of treatment weighting (IPTW) and generalized estimation equation modeling to account for clustering by institution. Despite these statistical adjustments, we agree that institutional and personal variations cannot be fully excluded as influencing factors.&lt;/p&gt;&lt;p&gt;Finally, the authors raised an important point regarding religious and socioeconomic influences. Previous research has indicated a limited correlation between these factors and DNAR decisions, especially within the Japanese healthcare and sociocultural environment.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; Japan's national health insurance provides comprehensive coverage, significantly reducing financial barriers to healthcare. Moreover, the cultural context in Japan, where individuals commonly practice multiple religions without adherence to a single doctrine, makes it less ","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871592","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":"Multiple trauma and shock vital signs as potential for improved outcome in patients with severe head trauma","authors":"Yuya Imanishi,&nbsp;Makoto Ohtake,&nbsp;Taisuke Akimoto,&nbsp;Takafumi Kawasaki,&nbsp;Masaki Yasuda,&nbsp;Kaoru Shizawa,&nbsp;Jun Suenaga,&nbsp;Takashi Kawasaki,&nbsp;Katsumi Sakata,&nbsp;Ichiro Takeuchi,&nbsp;Tetsuya Yamamoto","doi":"10.1002/ams2.70058","DOIUrl":"https://doi.org/10.1002/ams2.70058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate the prognostic factors in severe head trauma patients (Glasgow Coma Score (GCS) ≤ 8) with all trauma, including those with trunk injury as well as single severe head trauma (abbreviated injury scale (AIS) ≥ 3).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 152 consecutive patients with head trauma (AIS ≥ 3) and consciousness disorders (GCS ≤ 8) who were transported to our institute from January 2017 to October 2022. Data on the patients' background, vital signs at presentation, multiple trauma (AIS ≥ 3 in two or more locations), surgical intervention, and hematological findings were examined; a retrospective analysis was conducted with the modified Rankin Scale score after 3 months assigned as the primary outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The patients' mean age was 57.6 ± 23.4 years (0–89), 49 patients (32.2%) had multiple trauma, and 25 patients (16.4%) had accompanying shock vital signs. In the multivariate analysis of prognosis, age (<i>p</i> = 0.0007) and D-dimer levels (<i>p</i> = 0.0007) were independent poor prognostic factors. On the contrary, patients with multiple trauma (<i>p</i> = 0.027) and shock vital signs at presentation (<i>p</i> = 0.037) had a significantly better prognosis. In the non-shock group, 97.6% (41/42) of patients aged ≥50 years and with D-dimer level of 40 μg/mL or higher had a poor prognosis after 3 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Advanced age and high D-dimer levels are important independent associated factors in patients with severe consciousness disorder associated with head trauma; meanwhile, the prognosis is more favorable in patients whose consciousness disorders are associated with multiple trauma or circulatory failure, indicating that rapid improvement of circulatory failure may lead to better outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871593","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":"Unilateral temporal lobe atrophy after massive caffeine overdose","authors":"Yasuyoshi Miyamura,&nbsp;Tetsuhiro Takei,&nbsp;Taketo Suzuki,&nbsp;Kunihiko Okada","doi":"10.1002/ams2.70060","DOIUrl":"https://doi.org/10.1002/ams2.70060","url":null,"abstract":"<p>A 24-year-old man with autism spectrum disorder (ASD) and no history of seizures was admitted to the emergency department after ingesting 800 mg/kg of caffeine in a suicide attempt. He initially presented with generalized tonic–clonic seizures that lasted at least 40 min, which progressed to status epilepticus, necessitating continuous midazolam infusion for 4 days. Thereafter, he had no further convulsive seizures. On Day 8, fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) of the brain revealed a high-intensity signal in the left temporal lobe, suggestive of partial cerebral edema (Figure 1A–C). He resumed oral clonazepam for ASD from Day 12.</p><p>Two years after the caffeine overdose, the patient was admitted due to the recurrence of convulsive seizures. A subsequent brain MRI revealed marked atrophy of the left temporal lobe, especially the superior temporal and parahippocampal gyri, as observed on FLAIR (Figure 1D–F arrows and arrowheads). Clinically, he exhibited symptoms of depression, irritability, and dysmnesia.</p><p>In the rat hippocampal models, caffeine induced persistent neuronal bursting even after drug washout.<span>¹</span> Also, caffeine deteriorated epileptiform discharges in the hippocampal and parahippocampal gyrus in a patient with temporal lobe epilepsy.<span>²</span> This case suggests that nonconvulsive status epilepticus, following a massive caffeine overdose, can cause unilateral temporal lobe atrophy.</p><p>The authors declare no conflicts of interest.</p><p>Approval of the research protocol: N/A.</p><p>Informed consent: Informed consent was obtained from the patient.</p><p>Registry and registration no. of the study/trial: N/A.</p><p>Animal studies: N/A.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143871764","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":"Bronchiolitis obliterans due to toxic epidermal necrolysis with structural evaluation using computed tomography bronchography: A case report","authors":"Hidemasa Kudo,&nbsp;Ken Katsuta,&nbsp;Shigeki Kushimoto","doi":"10.1002/ams2.70046","DOIUrl":"https://doi.org/10.1002/ams2.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Toxic epidermal necrolysis (TEN) can lead to various extracutaneous complications, including respiratory involvement. We present a case of a patient who developed bronchiolitis obliterans (BO) after the acute phase of TEN, with computed tomography (CT) bronchography revealing bronchial tree structural changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 60-year-old woman presented with a rash and hoarseness 2 days after taking ibuprofen and was diagnosed with TEN. While her cutaneous symptoms improved by day 20, the flow-volume loop indicated obstructive respiratory failure. CT bronchography revealed bead-like changes and mural irregularities in the bronchi; thus, BO was diagnosed. Despite treatment with bronchodilators and steroids, she required long-term mechanical ventilation with persistent bronchial alterations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Extracutaneous complications of TEN are crucial, particularly in BO development following the acute phase. In this case, CT bronchography showed treatment-refractory bead-like changes and mural irregularities in the bronchioles.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"12 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831450","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}