Acute Medicine & Surgery最新文献

{"title":"Usefulness of the Yokohama Advanced Cardiopulmonary Help Team in patients with acute respiratory distress syndrome","authors":"Shusuke Utada,&nbsp;Hayato Taniguchi,&nbsp;Hiroshi Honzawa,&nbsp;Tomoaki Takeda,&nbsp;Takeru Abe,&nbsp;Ichiro Takeuchi","doi":"10.1002/ams2.953","DOIUrl":"https://doi.org/10.1002/ams2.953","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate whether establishing an extracorporeal membrane oxygenation (ECMO) specialist team, termed the Yokohama Advanced Cardiopulmonary Help Team (YACHT), affected the outcomes and centralization of patients requiring ECMO in Yokohama-Yokosuka regions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study included patients aged ≥18 years and treated with venovenous-ECMO for severe acute respiratory distress syndrome (ARDS) from 2014 to 2023. The primary outcome was intensive care unit (ICU) mortality. The secondary outcomes included ICU-, mechanical ventilator-, and ECMO-free days and complications during the first 28 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This study included 46 (12 without- and 34 with-YACHT) patients. Among with-YACHT patients, 24 were transferred to our hospital from other hospitals, 14 were assessed by dispatched ECMO physicians, and 9 were transferred after ECMO introduction. No without-YACHT patients were transferred from other hospitals. With-YACHT patients experienced coronavirus disease 2019-associated respiratory failure more frequently (0 vs. 27, <i>p</i> &lt; 0.001) and had higher Acute Physiology and Chronic Health Evaluation II scores (19 vs. 24, <i>p</i> = 0.037) and lower Respiratory Extracorporeal Membrane Oxygenation Survival Prediction scores (4 vs. 2, <i>p</i> = 0.021). ICU mortality was not significantly different between the groups (2 vs. 4, <i>p</i> = 0.67). ICU- (14 vs. 9, <i>p</i> = 0.10), ventilator- (11 vs. 5, <i>p</i> = 0.01), and ECMO-free days (20 vs. 14, <i>p</i> = 0.038) were higher before YACHT establishment. The incidences of complications were not significantly different between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Mortality was not significantly different pre- and post-YACHT establishment; however, it helped promote regionalization and centralization in Yokohama-Yokosuka areas. We will collect more cases to demonstrate YACHT's usefulness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.953","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140633789","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":"Three cases of neutralization of factor Xa inhibitors with andexanet alfa under rotational thromboelastography monitoring","authors":"Takeshi Yagi,&nbsp;Reina Kawano,&nbsp;Takuto Tomokage,&nbsp;Ryo Ayata,&nbsp;Yasutaka Koga,&nbsp;Kotaro Kaneda,&nbsp;Motoki Fujita,&nbsp;Nanami Yamanaka,&nbsp;Naomasa Mori,&nbsp;Ryosuke Tsuruta","doi":"10.1002/ams2.954","DOIUrl":"https://doi.org/10.1002/ams2.954","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Factor Xa inhibitors are direct oral anticoagulants that are extremely useful in clinical applications, safe, and do not require dose adjustment. It is desirable to be able to monitor their effects in the event of hemorrhagic complications requiring neutralization. However, it is difficult to monitor their activity and neutralization using conventional coagulation tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>We report three patients taking factor Xa inhibitors who underwent rotational thromboelastography (ROTEM) monitoring before and after neutralization with andexanet alfa. All three patients had hemorrhagic complications that required neutralization of their factor Xa inhibitors using andexanet alfa. One ROTEM parameter, the EXTEM clotting time (EXTEM-CT), was immediately shortened after andexanet alfa bolus administration, without subsequent extension of the EXTEM-CT assessed 4 h after the bolus dose.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ROTEM parameters, particularly EXTEM-CT, might be useful for monitoring neutralization of factor Xa inhibitors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.954","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140633762","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":"Secondary thrombotic microangiopathy with generalized purpura in a young woman","authors":"Tatsunori Nagamura,&nbsp;Soichiro Seno,&nbsp;Yasumasa Sekine,&nbsp;Tetsuro Kiyozumi","doi":"10.1002/ams2.949","DOIUrl":"https://doi.org/10.1002/ams2.949","url":null,"abstract":"<p>A 22-year-old woman with no previous medical history presented with shock and extensive purpura spots after a sudden rash on both upper limbs and trunk (Figure 1A–C). Blood tests revealed multiple organ failure, increased inflammatory response, and coagulation abnormalities. We started antibiotics for septic shock with purpura fulminans; however, pancytopenia with hemolytic anemia and renal failure worsened. We diagnosed thrombotic microangiopathy (TMA) including thrombotic thrombocytopenic purpura (TTP) and initiated plasma exchange (PE) on Day 3. Five PE rounds dramatically improved her condition; however, dry necrosis remained in both hands. We amputated the necrotic tissue 18 days after admission, from the distal end of the basal phalanx of the second to fifth finger. She was discharged on Day 60. The trunk healed without scarring; however, scars were left on the upper limbs (Figure 1D–F). Biopsy findings from the abdomen and left knee indicated TMA. Culture and immunological tests, including ADAMTS13 activity, were negative. She had fever, cold symptoms, and arthritis 2 days before admission, leading to viral infection-induced secondary TMA diagnosis. Secondary TMA rarely presents with extensive purpura, although its involvement in infection-related TMA is reported.<span>^{1, 2}</span> PE should be aggressively performed for secondary TMA, especially when caused by infection.</p><p>The authors declare no conflicts of interest.</p><p>Approval of the research protocol: None.</p><p>Informed consent: Informed consent was obtained from the patient and parents.</p><p>Registry and the registration no. of the study/trial: None.</p><p>Animal studies: None.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.949","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140633726","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":"Efficacy of antithrombin administration for patients with sepsis: A systematic review, meta-analysis, and meta-regression","authors":"Takumi Tsuchida,&nbsp;Yuto Makino,&nbsp;Takeshi Wada,&nbsp;Noritaka Ushio,&nbsp;Takaaki Totoki,&nbsp;Naoki Fujie,&nbsp;Shunsuke Yasuo,&nbsp;Tadashi Matsuoka,&nbsp;Hiroyuki Koami,&nbsp;Kazuma Yamakawa,&nbsp;Toshiaki Iba","doi":"10.1002/ams2.950","DOIUrl":"https://doi.org/10.1002/ams2.950","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>There have been inconsistent reports regarding the effect of antithrombin on sepsis; furthermore, there are limited reports on how dosage affects therapeutic efficacy. Thus, we aimed to perform a systematic review and meta-analysis of the use of antithrombin for sepsis and a meta-regression analysis of antithrombin dosage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included randomized controlled trials (RCTs) and observational studies of adult patients with sepsis who received antithrombin. Outcomes included all-cause mortality and serious bleeding complications. Statistical analyses and data synthesis were performed using a random-effects model; further, meta-regression and funnel plots were used to explore heterogeneity and biases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven RCTs and six observational studies were included. Most patients in the RCTs and observational studies had severe sepsis and septic-disseminated intravascular coagulation (DIC), respectively. A meta-analysis using RCTs showed no significant differences in mortality between the antithrombin and control groups. However, the meta-analysis of observational studies indicated a trend of decreasing mortality rates with antithrombin administration (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.68–0.92; <i>p</i> = 0.002). Bleeding complications were significantly higher in the antithrombin group than in the control group in both study types (OR, 1.90; 95% CI, 1.52–2.37; <i>p</i> &lt; 0.01). The meta-regression analysis showed no correlation between antithrombin dosage and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A meta-analysis of RCTs confirmed no survival benefit of antithrombin, whereas that of observational studies, which mostly focused on septic DIC, showed a significant beneficial effect on improving outcomes. Indications of antithrombin should be considered based on its beneficial and harmful effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.950","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140606362","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":"Prognostic factors in mobility disability among elderly patients in the emergency department: A single-center retrospective study","authors":"Akiyoshi Nagatomi,&nbsp;Haruaki Wakatake,&nbsp;Yoshihiro Masui,&nbsp;Shigeki Fujitani","doi":"10.1002/ams2.951","DOIUrl":"https://doi.org/10.1002/ams2.951","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We aimed to evaluate the clinical characteristics and outcomes of elderly critically ill patients and identify prognostic factors for mobility disability at discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, retrospective cohort study investigated the period from April 2020 to January 2021. Patients ≥75 years old transferred to our emergency department and admitted to the intensive care unit (ICU) or intermediate unit in our hospital were eligible. Demographics, clinical characteristics, nutritional indicators, and nutritional screening scores were collected from chart reviews and analyzed. The primary outcome was the prevalence of mobility disability, compared to that of no mobility disability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 124 patients were included in this present study. Median age was 83.0 years (interquartile range [IQR], 79.8–87.0 years) and 48 patients (38.7%) were female. Fifty-two patients (41.9%) could not walk independently at discharge (mobility disability group). The remaining 72 patients were in the no mobility disability group. Multiple logistic regression analyses revealed clinical frailty scale (CFS) score ≥5 (odds ratio [OR] = 6.63, 95% confidence interval [CI] = 2.51–17.52, <i>p</i> &lt; 0.001), SOFA score ≥6 (OR = 6.11, 95% CI = 1.57–23.77, <i>p</i> = 0.009), and neurological disorder as the main cause on admission (OR = 4.48, 95% CI = 1.52–13.20, <i>p</i> = 0.006) were independent and significant prognostic factors for mobility disability at discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among elderly patients admitted to the emergency department, CFS ≥5, SOFA ≥6, and neurological disorders were associated with mobility disability at hospital discharge.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.951","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140606239","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":"Association between eGFR and neurological outcomes among patients with out-of-hospital cardiac arrest: A nationwide prospective study in Japan","authors":"Kenji Kandori,&nbsp;Asami Okada,&nbsp;Satoshi Nakajima,&nbsp;Tasuku Matsuyama,&nbsp;Tetsuhisa Kitamura,&nbsp;Hiromichi Narumiya,&nbsp;Ryoji Iizuka,&nbsp;Masahito Hitosugi,&nbsp;Yohei Okada","doi":"10.1002/ams2.952","DOIUrl":"https://doi.org/10.1002/ams2.952","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We aimed to investigate the association between estimated glomerular filtration rate and prognosis in out-of-hospital cardiac arrest patients and explore the heterogeneity of the association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients experiencing out-of-hospital cardiac arrest due to medical causes and registered in the JAAM-OHCA Registry between June 2014 and December 2019 were stratified into shockable rhythm, pulseless electrical activity, and asystole groups according to the cardiac rhythm at the scene. The primary outcome was a 1-month favorable neurological status. Adjusted odds ratios with 95% confidence intervals were calculated to investigate the association between estimated glomerular filtration rate and outcomes using a logistic model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 19,443 patients included, 2769 had initial shockable rhythm at the scene, 5339 had pulseless electrical activity, and 11,335 had asystole. As the estimated glomerular filtration rate decreased, the adjusted odds ratio for a 1-month favorable neurological status decreased among those with initial shockable rhythm (estimated glomerular filtration rate, adjusted odds ratio [95% CI]: 45–59 mL/min/1.73 m², 0.61 [0.47–0.79]; 30–44 mL/min/1.73 m², 0.45 [0.32–0.62]; 15–29 mL/min/1.73 m², 0.35 [0.20–0.63]; and &lt;15 mL/min/1.73 m², 0.14 [0.07–0.27]). Estimated glomerular filtration rate was associated with neurological outcomes in patients aged &lt;65 years with initial shockable rhythm but not in those aged &gt;65 years or patients with initial pulseless electrical activity or asystole.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The estimated glomerular filtration rate is associated with neurological prognosis in out-of-hospital cardiac arrest patients with initial shockable rhythm at the scene but not in those with initial non-shockable rhythm.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.952","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140606241","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":"Penetrating cardiac injury caused by multiple rib fractures following high-energy trauma: Usefulness of the exploratory video-assisted thoracoscopic surgery","authors":"Keisuke Tetsumoto,&nbsp;Masakazu Takayama,&nbsp;Tadaaki Koyama,&nbsp;Hidenao Kayawake,&nbsp;Masao Saito,&nbsp;Ken Nakamura,&nbsp;Yutaka Takahashi,&nbsp;Hiroshi Hamakawa","doi":"10.1002/ams2.938","DOIUrl":"https://doi.org/10.1002/ams2.938","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Penetrating cardiac injuries are usually fatal and associated with poor survival rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 69-year-old man was injured in a motor vehicle accident and suffered from left hemothorax and multiple rib fractures near the heart. A comprehensive assessment raised suspicions of lacerated pericardium and myocardial injury. Consequently, a thoracoscopy was performed 9 h after injury. A penetrating cardiac injury was detected and surgically treated via video-assisted thoracoscopic surgery. The patient recovered uneventfully and was discharged on postoperative day 16.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Exploratory video-assisted thoracoscopic surgery may play a key role in the primary diagnosis of patients with high-energy chest traumas with cardiac injury and simultaneously allow for the appropriate surgical interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.938","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140537792","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":"Analysis of comprehensive biomolecules in critically ill patients via bioinformatics technologies","authors":"Hisatake Matsumoto,&nbsp;Hiroshi Ogura,&nbsp;Jun Oda","doi":"10.1002/ams2.944","DOIUrl":"https://doi.org/10.1002/ams2.944","url":null,"abstract":"<p>Each patient with a critical illness such as sepsis and severe trauma has a different genetic background, comorbidities, age, and sex. Moreover, pathophysiology changes dynamically over time even in the same patient. Therefore, individualized treatment is necessary to account for heterogeneity in patient backgrounds. Recently, the analysis of comprehensive biomolecular information using clinical specimens has revealed novel molecular pathological classifications called subtypes. In addition, comprehensive biomolecular information using clinical specimens has enabled reverse translational research, which is a data-driven approach to the identification of drug target molecules. The development of these methods is expected to visualize the heterogeneity of patient backgrounds and lead to personalized therapy.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.944","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140537793","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":"Coronary computed tomography–angiography for traumatic coronary artery transection","authors":"Kenta Nagashima,&nbsp;Tomohiro Hayashida,&nbsp;Eiji Yamada,&nbsp;Naoki Ishibashi,&nbsp;Naoki Mimura,&nbsp;Nobuhiro Kashitani","doi":"10.1002/ams2.946","DOIUrl":"https://doi.org/10.1002/ams2.946","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Penetrating thoracic trauma with coronary artery transection is a lethal injury, but is rare. We report a case of a cardiac stab wound with coronary artery transection that was successfully treated after preoperative diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 36-year-old man was transferred to our emergency department with a left chest stab wound. A coronary computed tomography-angiography scan, including coronary angiography, revealed left hemopneumothorax and left anterior descending branch transection, with ischemic changes in the left ventricular myocardium. Given the diagnosis of coronary artery transection and the absence of injury to the surrounding arteries, we were able to perform coronary artery bypass surgery using the left internal thoracic artery. The patient's postoperative course was good, and he was discharged on foot without major complications 18 days after surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Unless a resuscitative thoracotomy is required, a preoperative computed tomography scan, including coronary angiography, may be useful for accurate preoperative diagnosis for patients at high risk of myocardial or coronary artery injury.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.946","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140348659","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":"Medial pontine mid-tegmentum syndrome","authors":"Junpei Komagamine,&nbsp;Satsuki Yoshihara,&nbsp;Yasuhiro Kano","doi":"10.1002/ams2.948","DOIUrl":"https://doi.org/10.1002/ams2.948","url":null,"abstract":"<p>A 74-year-old man presented to the emergency department with acute diplopia and transient left-sided paresthesia of the upper and lower limbs. He reported no headaches, dizziness, or vision loss. Upon presentation, he was alert and oriented. Neurological examination revealed right abducens nerve palsy with diplopia on the right lateral gaze (Figure 1A). His left-sided paresthesia had improved on presentation, and there were no other neurological findings. Brain magnetic resonance imaging (MRI) revealed a small infarct in the right pontine tegmentum (Figure 1B,C). Magnetic resonance angiography revealed no significant stenosis of the cerebral arteries. Dual antiplatelet therapy was started, and his right abducens nerve palsy gradually resolved. He was discharged after a one-week hospital stay.</p><p>To our knowledge, this is the second report of medial pontine mid-tegmentum syndrome<span>¹</span> resulting from damage to the mid-lateral portion of the medial lemniscus of the pons. Because the abducens nerve crosses the medial lemniscus at the pontine level, this syndrome is associated with ipsilateral abducens nerve palsy and contralateral sensory disturbance<span>¹</span> (Figure 1D). Given the limited sensitivity of MRI for detecting ischemic stroke of the posterior circulation,<span>²</span> recognition of this syndrome as one of the stroke syndromes is critical for prompt intervention.</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 the registration no. of the study/trial: N/A.</p><p>Animal studies: N/A.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.948","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140348647","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}