Journal of UOEH
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Case Reports
[A case of acute chronic respiratory failure due to fat embolism syndrome after the left femoral neck fracture].
A 78 year old Japanese woman was transferred to our hospital for the treatment of a fracture of the left femoral neck in April, 2010. She had been taking oral corticosteroid (prednisolone 5 mg/day) for the treatment of idiopathic interstitial pneumonia since 2003, and had been treated by home oxygen therapy since 2007. She fell in the restroom at home and hurt herself, and was transferred to our hospital for treatment of a left femoral neck fracture in April, 2010. ⋯ However, the elevation of D-dimer over time and characteristic findings of petechial hemorrhagic lesions on her palpebral conjunctivae and neck with microscopic findings of phagocytized lipid in alveolar macrophages in her endobronchial secretion led to the diagnosis of fat embolism syndrome. She was successfully treated with high-dose corticosteroid and sivelestat sodium, and she was discharged on the 21st day after admission. Although a differential diagnosis of acute exacerbation of interstitial pneumonia and fat embolism syndrome was necessary and difficult in the present case, characteristic findings of petechial hemorrhagic lesions of skin, palpebral conjunctiva and lipid-laden alveolar macrophages in endotracheal aspirate were useful for the accurate and prompt diagnosis of fat embolism syndrome.
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Case Reports
[A case of intraoperative latex anaphylaxis during general anesthesia for rectal cancer resection].
A 72-year-old woman underwent high anterior resection for rectal cancer. Fifteen minutes after the start of the operation, the pressure on the respiratory tract rose, blood pressure and SpO2 dropped, and skin rash, wheezing and ECG disorder appeared. The anesthesiologist suspected latex anaphylaxis and interrupted the operation. ⋯ Post-operation, she showed positive reaction to latex specific IgE, suggesting that the anaphylaxis was induced by latex allergy. A re-operation was performed under a latex-free environment. No allergic reaction was seen during or after the re-operation.
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Hypotension and shock can be classified as hypotension caused by reduced or maintained left ventricular (LV) ejection. Reduced left ventricular ejection can result from intrinsic left ventricular, aortic valve or mitral valve failure, which includes dilated or ischemic cardiomyopathy, left main trunk disease, acute myocarditis, etc. Acute and subacute severe aortic regurgitation can also cause shock. ⋯ Pseudohypotension may result from aortic dissection, Takayasu's arteritis, arteriosclerosis obliterans and aortic coarctation. A right parasternal approach enables better visualization of the ascending aorta. Fundamental echochocardiographic scanning allows approximate yet useful diagnosis of hypotension and shock.
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Cancer chemotherapy regimens which had been used at a ward and outpatient chemotherapy in various departments were collected and made available to everybody in October, 2003. However, it was difficult to manage cancer chemotherapy regimens in real time, from the viewpoint of risk management. ⋯ Inquiries on prescription by the pharmacist contributed to proper medical treatment. The role of the cancer chemotherapy exploratory committee and its outcome are described for the purpose of the prevention of medical accidents in this paper.
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The prevalence and mortality of chronic obstructive pulmonary disease (COPD) is expected to increase in the future throughout the world. Little data is available on the prevalence of airflow limitation in Japan, especially on medical check-up. The purpose of this study was to assess the prevalence of airflow limitation in Japanese subjects during medical check-ups. ⋯ In females, the prevalence of mild, moderate, severe and very severe airflow limitation was 2.67, 0.63, 0.02 and 0.00%, respectively. Only 10 cases with airflow limitation reported a previous diagnosis of COPD. These results suggest that screening spirometry during medical check-ups can identify many COPD patients not aware of this disease and highlight the need for enhanced screening efforts, intervention and treatment.