Acute Medicine & Surgery最新文献

{"title":"Feasibility of Early Enteral Nutrition in Patients Under Mechanical Circulatory Support","authors":"Chikai Mitsuhara,&nbsp;Kentaro Shimizu,&nbsp;Takeshi Ebihara,&nbsp;Hiroshi Ogura,&nbsp;Jun Oda","doi":"10.1002/ams2.70132","DOIUrl":"10.1002/ams2.70132","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to evaluate whether early enteral nutrition can be administered without increasing gastrointestinal complications in patients receiving mechanical circulatory support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study was conducted at a tertiary hospital in Japan. We consecutively included adult patients supported with intra-aortic balloon pumping alone or with both intra-aortic balloon pumping and veno-arterial extracorporeal membrane oxygenation who remained in the intensive care unit for &gt; 1 week between January 2010 and December 2019. Patients were divided into an early group (enteral nutrition initiated within 48 h of admission) and a late group (enteral nutrition initiated after 48 h). The study endpoints were the amount of energy administered in each group and the frequency of gastrointestinal complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-five patients were eligible, including 16 in the early group and 39 in the late group. Time from admission to enteral nutrition initiation was 1.5 (1–2) days in the early group and 4.5 (3–6.5) days in 24 late-group patients who received enteral nutrition. Energy administered per ideal body weight increased earlier in the early group and differed significantly from Day 2 to Day 5, whereas no significant difference was observed after Day 6. No significant differences were found in gastrointestinal complications or mortality between groups; mortality was 7 patients (35%) in the early group and 17 patients (44%) in the late group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings suggest that early enteral nutrition may be a feasible option in carefully selected patients receiving mechanical circulatory support during intensive care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216019","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 “Repositioning POCUS in the Diagnostic Landscape of Gastric Anisakiasis: A Call Toward Pragmatic Integration”","authors":"Yuya Kitai,&nbsp;Ryota Sato,&nbsp;Tetsuya Inoue","doi":"10.1002/ams2.70137","DOIUrl":"10.1002/ams2.70137","url":null,"abstract":"<p>We sincerely thank Rattanapitoon et al. for their insightful comments provided on our article, “Gastric anisakiasis suspected by point-of-care ultrasound finding in the emergency department.” and for expanding the discussion on this important topic. We are in strong agreement with the key perspectives they have put forward.</p><p>Rattanapitoon et al. correctly highlight that the combination of a detailed clinical history and a focused POCUS examination represents a powerful synergy. This concept is strongly supported by evidence. For instance, Börner et al. state that a correct diagnosis for acute abdomen can be established in 53%–83% of cases based on abdominal ultrasound combined with history and physical examination [<span>1</span>]. This foundational clinical assessment is pivotal. It elevates the pre-test probability, allowing us to interpret a POCUS finding, such as the thickened gastric wall in our case, not as an isolated, non-specific sign, but as a key piece of evidence pointing towards a specific diagnosis [<span>2</span>].</p><p>We wish to echo and further expand on their call for the “pragmatic integration” of POCUS. Its utility is not confined to specific gastrointestinal infections. We believe that the thoughtful application of POCUS across a wide spectrum of acute abdominal conditions can lead to more rational utilization of computed tomography (CT) and facilitate more rapid diagnoses. By providing immediate anatomical insights at the bedside, POCUS can serve as a crucial gatekeeper, helping to ensure that the diagnostic power of CT is reserved for cases where it is truly necessary, thereby optimizing resources and minimizing radiation exposure.</p><p>To achieve this, enhancing pre-test probability is paramount, a point Rattanapitoon et al. astutely raise with their proposal for clinical scoring systems. The diagnostic value of POCUS is amplified significantly when it is used to confirm a high-probability suspicion rather than as a tool for open-ended exploration. This targeted approach is essential for maximizing its clinical impact.</p><p>Finally, we wholeheartedly concur with their most critical point: the urgent need for standardization in POCUS education and application. The current variability in POCUS utilization among clinicians, largely due to a lack of standardized training curricula for less common applications, is a significant barrier to its effective, widespread adoption. We must prioritize the accumulation of robust evidence for these “minor” applications. This evidence is the foundation upon which we can build standardized, competency-based training programs and clinical protocols.</p><p>We thank Rattanapitoon et al. once again for their valuable contribution. Their letter reinforces the need for a collaborative, evidence-based approach to defining the role of POCUS in modern emergency medicine.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148209862","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":"Complications of Femoral Artery Sheath Insertion in Non-Fluoroscopic Resuscitation: A Single-Center Observational Study.","authors":"Takahiro Michishita, Naoya Suzuki, Takeru Abe, Akiyuki Yumori, Tomoki Doi, Ichiro Takeuchi","doi":"10.1002/ams2.70134","DOIUrl":"10.1002/ams2.70134","url":null,"abstract":"<p><strong>Aim: </strong>Femoral artery sheath insertion is a common resuscitation procedure; however, most research on complications focuses on cardiovascular medicine. No studies have examined sheath insertion complications in emergency or intensive care settings where fluoroscopy is unavailable. This study investigated complications associated with femoral artery sheath insertion in non-fluoroscopic resuscitation.</p><p><strong>Methods: </strong>This retrospective, single-center observational study included patients who underwent femoral artery sheath insertion for resuscitation under non-fluoroscopic conditions between April 2014 and August 2024 and subsequently underwent computed tomography. Patients were categorized into the non-complication and complication groups. Vascular and skin insertion positions were measured using computed tomography, and patient backgrounds were compared between groups.</p><p><strong>Results: </strong>The study included 151 patients in the non-complication group and 16 in the complication group, yielding a complication rate of 9.6%. A significant difference was observed in sheath insertion position (<i>p</i> < 0.001). The proportion of sheath insertions at the level of the femoral head was higher in the non-complication group, whereas insertions below the femoral head were more frequent in the complication group.</p><p><strong>Conclusion: </strong>Femoral artery sheath insertion without fluoroscopy during resuscitation was associated with a 9.6% complication rate, with the complication group having a higher rate of vascular puncture below the femoral head than the non-complication group.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 ","pages":"e70134"},"PeriodicalIF":1.4,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147961752","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":"Severe Liver Injury Complicated by Portal Hypertension and Traumatic Arterioportal Shunt: A Case Report.","authors":"Yusuke Miura, Koichiro Sueyoshi, Jin Hashimoto, Juri Inoue, Kentaro Seki, Yutaka Kondo, Hisayo Okazaki, Kana Takechi, Tomohiko Ai, Hiroshi Tanaka, Ken Okamoto","doi":"10.1002/ams2.70135","DOIUrl":"10.1002/ams2.70135","url":null,"abstract":"<p><strong>Background: </strong>Traumatic arterioportal (AP) shunts are rare vascular complications of hepatic trauma. In patients with severe liver injury, portal hypertension and hepatic dysfunction may develop during the postoperative course, and delayed AP shunts can be difficult to detect on computed tomography.</p><p><strong>Case presentation: </strong>We report the case of a 19-year-old male who sustained a severe blunt liver injury in a motorcycle accident and presented with hemorrhagic shock. After initial surgical and endovascular hemostatic management, he developed progressive portal hypertension, worsening hepatic dysfunction, and persistent large-volume abdominal fluid. A multiphasic computed tomography scan performed on hospital day 32 showed no definite arterioportal shunt, although splenomegaly and gastrointestinal wall edema were present. On hospital day 39, angiography revealed an AP shunt between the right hepatic artery and the posterior branch of the portal vein. The shunt was treated with transcatheter arterial embolization, after which the patient showed gradual clinical improvement, including reduction of ascitic drainage and recovery of portal venous flow direction on follow-up ultrasonography.</p><p><strong>Conclusion: </strong>This case highlights that traumatic AP shunts may be identified during the course of severe liver injury with portal hypertension and hepatic dysfunction, even when computed tomography is initially negative. Angiography should be considered when delayed vascular complications are suspected, and timely embolization may contribute to clinical improvement.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 ","pages":"e70135"},"PeriodicalIF":1.4,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147961841","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148076775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148076776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Geographic Distance and Prehospital Delay on Mortality and Functional Outcomes in Severe Traumatic Brain Injury in a Low-Resource Setting.","authors":"Syed Shayan Shah, Muhammad Nawaz Khan, Muhammad Sohaib Khan, Adnan Khan, Syed Jawad Ahmad, Sadia Shafique","doi":"10.1002/ams2.70131","DOIUrl":"10.1002/ams2.70131","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) disproportionately affects low- and middle-income countries (LMICs), where prehospital delays and geographic barriers may adversely impact outcomes.</p><p><strong>Methods: </strong>This retrospective study included 1068 consecutive patients with severe TBI (admission Glasgow Coma Scale [GCS] < 9) admitted to Lady Reading Hospital, Peshawar, in 2024. Variables were incident-to-presentation delay, distance, in-hospital timings to surgery, severity markers, mortality, and discharge Glasgow Outcome Scale (GOS). Patients were stratified by urban or rural area according to the place of incident. Statistical analyses included the Mann-Whitney U test, chi-square test, and multivariable logistic regression.</p><p><strong>Results: </strong>The In-hospital mortality was 12.2%, and poor outcomes (GOS ≤ 3) were observed in 95.9%. The median delay before presentation was 6 h (IQR 3-9), with a median distance of 70 km (IQR 6-210). Delays were significantly longer in rural patients (median 9 vs. 3 h in urban areas, <i>p</i> < 0.001), and distances to presentation were also greater (median 180 km vs. 40 km, <i>p</i> < 0.001), with rural patients accounting for 72%. The median in-hospital intervention time was 42 min. No significant differences in mortality were found between the high-delay and high-distance groups (13.1% vs. 11.3%, <i>p</i> = 0.41; 12.8% vs. 11.6%, <i>p</i> = 0.62) or between rural and urban patients (12.5% vs. 11.4%, <i>p</i> = 0.69). Multivariable analysis demonstrated no independent association between geographic factors and mortality after adjustment for injury severity.</p><p><strong>Conclusions: </strong>Significant disparities in prehospital access were observed; however, no independent association between geographic factors and in-hospital mortality among admitted patients was identified. Functional outcomes remained poor.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 ","pages":"e70131"},"PeriodicalIF":1.4,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809138","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148093740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Myasthenia Gravis Diagnosed After Hospitalization in a Patient Receiving Home Oxygen Therapy for Respiratory Failure.","authors":"Yuki Yamamoto, Atsunori Onoe, Shohei Ono, Yoshihiro Nakamura, Takahiro Oishi, Fumiko Nakamura, Mari Nakajima, Kazuhito Sakuramoto, Takashi Muroya, Kentaro Kajino, Hitoshi Ikegawa, Yasuyuki Kuwagata","doi":"10.1002/ams2.70127","DOIUrl":"10.1002/ams2.70127","url":null,"abstract":"<p><strong>Introduction: </strong>Respiratory failure has various causes, including neuromuscular disorders. We report a case of myasthenic crisis requiring intensive care after a delayed diagnosis.</p><p><strong>Case presentation: </strong>A woman in her 70s had been on home oxygen therapy for 10 months due to dyspnea. She was admitted with worsening dyspnea, type II respiratory failure, and pneumonia requiring mechanical ventilation. Although her pneumonia improved, ventilator weaning was unsuccessful. Muscle weakness raised suspicion of neuromuscular disease. Myasthenia gravis was a differential diagnosis, but she showed no thymoma, ocular symptoms, or abnormal findings on edrophonium or repetitive nerve stimulation tests. On Day 19, she tested positive for MuSK antibodies and myasthenia gravis was diagnosed. She was treated with prednisone, tacrolimus, intravenous immunoglobulin, and plasmapheresis. She was successfully weaned from mechanical ventilation and discharged home on hospital Day 81.</p><p><strong>Conclusion: </strong>Myasthenia gravis should be considered as a differential diagnosis of unexplained respiratory failure.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 ","pages":"e70127"},"PeriodicalIF":1.4,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759564","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"13 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148091692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}