Case: A 55-year-old man without past medical histories suffering from back pain for two weeks was successfully resuscitated from an 8-min cardiopulmonary arrest (CPA) and was brought to our hospital by ambulance. Comp...Case: A 55-year-old man without past medical histories suffering from back pain for two weeks was successfully resuscitated from an 8-min cardiopulmonary arrest (CPA) and was brought to our hospital by ambulance. Computed tomography demonstrated type A acute aortic dissection (AAAD) with brachiocephalic artery occlusion. After admission, Glasgow Coma Scale score improved to E1VTM4, and voluntary movement was noted only in the right limbs. Outcome: The patient underwent emergency grafting of the ascending aorta and innominate artery under deep hypothermic circulatory arrest. After surgery, the patient recovered with mild disorientation and left hemiplegia. Magnetic resonance imaging of the head revealed no large infarction but revealed multiple acute ischemic changes. One year later, the patient demonstrated independent walk and successfully returned to work life. Conclusions: Immediate resuscitation and surgery resulted in good recovery from CPA after AAAD.展开更多
Background:Burns resulting from assaults account for considerable morbidity and mortality among patients with burn injuries around the world.However,it is still unclear whether unfavorable clinical outcomes are associ...Background:Burns resulting from assaults account for considerable morbidity and mortality among patients with burn injuries around the world.However,it is still unclear whether unfavorable clinical outcomes are associated primarily with the severity of the injuries.To elucidate the direct relationship between burns resulting from assaults and mortality and/or length of hospital stays,we performed this study with the hypothesis that burns from assault would be independently associated with fewer hospital-free days than would burns from other causes,regardless of the severity of burn injuries.Methods:We conducted a retrospective cohort study,using a city-wide burn registry(1996–2017)accounting for 14 burn centers in Tokyo,Japan.Patients who arrived within 24 hours after injury were included,and those with self-inflicted burn injuries were excluded.Patients were divided into two groups according to mechanism of burns(assault vs.accident),and the number of hospitalfree days until day 30 after injury(a composite of in-hospital death and hospital length of stay)was compared between the groups.To estimate the probability that an injury would be classified as an assault,we calculated propensity scores,using multivariate logistic regression analyses adjusted for known outcome predictors.We also performed an inverse probability weighting(IPW)analysis to compare adjusted numbers of hospital-free days.Results:Of 7419 patients in the registry with burn injuries during the study period,5119 patients were included in this study.Of these,113(2.2%)were injured as a result of assault;they had significantly fewer hospital-free days than did those with burns caused by accident(18[27]vs.24[20]days;coefficient=−3.4[−5.5 to−1.3]days;p=0.001).IPW analyses similarly revealed the independent association between assault burn injury and fewer hospital-free days(adjusted coefficient=−0.6[−1.0 to−0.1]days;p=0.009).Conclusions:Burn from assault was independently associated with fewer hospital-free days,regardless of the severity of burn injuries.The pathophysiological mechanism underlying the relationship should be further studied in a prospective observational study.展开更多
文摘Case: A 55-year-old man without past medical histories suffering from back pain for two weeks was successfully resuscitated from an 8-min cardiopulmonary arrest (CPA) and was brought to our hospital by ambulance. Computed tomography demonstrated type A acute aortic dissection (AAAD) with brachiocephalic artery occlusion. After admission, Glasgow Coma Scale score improved to E1VTM4, and voluntary movement was noted only in the right limbs. Outcome: The patient underwent emergency grafting of the ascending aorta and innominate artery under deep hypothermic circulatory arrest. After surgery, the patient recovered with mild disorientation and left hemiplegia. Magnetic resonance imaging of the head revealed no large infarction but revealed multiple acute ischemic changes. One year later, the patient demonstrated independent walk and successfully returned to work life. Conclusions: Immediate resuscitation and surgery resulted in good recovery from CPA after AAAD.
文摘Background:Burns resulting from assaults account for considerable morbidity and mortality among patients with burn injuries around the world.However,it is still unclear whether unfavorable clinical outcomes are associated primarily with the severity of the injuries.To elucidate the direct relationship between burns resulting from assaults and mortality and/or length of hospital stays,we performed this study with the hypothesis that burns from assault would be independently associated with fewer hospital-free days than would burns from other causes,regardless of the severity of burn injuries.Methods:We conducted a retrospective cohort study,using a city-wide burn registry(1996–2017)accounting for 14 burn centers in Tokyo,Japan.Patients who arrived within 24 hours after injury were included,and those with self-inflicted burn injuries were excluded.Patients were divided into two groups according to mechanism of burns(assault vs.accident),and the number of hospitalfree days until day 30 after injury(a composite of in-hospital death and hospital length of stay)was compared between the groups.To estimate the probability that an injury would be classified as an assault,we calculated propensity scores,using multivariate logistic regression analyses adjusted for known outcome predictors.We also performed an inverse probability weighting(IPW)analysis to compare adjusted numbers of hospital-free days.Results:Of 7419 patients in the registry with burn injuries during the study period,5119 patients were included in this study.Of these,113(2.2%)were injured as a result of assault;they had significantly fewer hospital-free days than did those with burns caused by accident(18[27]vs.24[20]days;coefficient=−3.4[−5.5 to−1.3]days;p=0.001).IPW analyses similarly revealed the independent association between assault burn injury and fewer hospital-free days(adjusted coefficient=−0.6[−1.0 to−0.1]days;p=0.009).Conclusions:Burn from assault was independently associated with fewer hospital-free days,regardless of the severity of burn injuries.The pathophysiological mechanism underlying the relationship should be further studied in a prospective observational study.
