基本情報
研究キーワード
1経歴
9-
2019年4月 - 現在
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2017年4月 - 2019年3月
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2008年 - 2017年3月
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2005年 - 2008年
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2003年 - 2005年
学歴
1-
1990年4月 - 1996年3月
委員歴
6-
2020年 - 現在
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2019年 - 現在
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2016年 - 現在
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2014年 - 現在
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2011年 - 現在
受賞
2論文
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Radiology case reports 14(5) 623-626 2019年5月 査読有り
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Radiology case reports 14(2) 251-254 2019年2月 査読有りSurgical treatment of mesenteric injuries is necessary to control hemorrhage, manage bowel injuries, and evaluate bowel perfusion. It has recently been suggested that some patients can be managed with transcatheter arterial embolization (TAE) for initial hemostasis. We present a hemodynamically unstable patient who was initially managed by TAE for traumatic mesenteric hemorrhage. A 60-year-old man was injured in a motor vehicle accident and transported to our facility. On arrival, the patient was hemodynamically stable, and had abdominal pain. Physical examination revealed a seatbelt sign on the lower abdomen. A contrast-enhanced computed tomography (CT) scan showed intra-abdominal hemorrhage, mesenteric hematoma, and a giant-pseudoaneurysm, but no intra-abdominal free air or changes in the appearance of the bowel wall. After the CT scan, his vital signs deteriorated and surgical intervention was considered, but TAE was performed to control the hemorrhage. After TAE, the patient was hemodynamically stable and had no abdominal tenderness. A follow-up CT scan was performed 2 days later which showed partial necrosis of the transverse colon and some free air. Resection of the injured transverse colon with primary anastomosis was performed. The patient improved and was discharged 35 days after injury. TAE can be effective as the initial hemostatic procedure in patients with traumatic mesenteric hemorrhage.
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Injury 50(1) 205-209 2019年1月 査読有りBACKGROUND: Although K-cars, small four-wheeled vehicles with an engine capacity of <660 cc, have been used almost exclusively in Japan, they have recently become increasingly popular in other countries. Therefore, reporting the characteristics of bodily injuries sustained by K-car drivers after road traffic accidents (RTAs) may be important not only for health professionals but also for car manufacturers. METHODS: A single-center, retrospective observational study was conducted using prospectively acquired data. Between January 2010 and December 2017, 494 restrained drivers (331 men/163 women with a mean age of 45.1 years) whose vehicles had been severely damaged in RTAs underwent whole-body computed tomography prospectively. They were subsequently dichotomized into 221 K-car drivers and 273 standard vehicle drivers and compared for severity and distribution of bodily injuries. RESULTS: K-car drivers tended to be older and were significantly more likely to be female than standard vehicle drivers. The frequency of subjects with severe bodily injuries significantly higher among K-car drivers than among standard vehicle drivers (21.7% vs. 14.3%; p = 0.04), and the frequency of bowel/mesentery injuries tended to be higher in the former (9.0% vs. 4.4%; p = 0.06). However, the frequency of abdominal solid viscus injuries did not differ significantly between the two groups. Multivariable regression analysis showed that age [odds ratio (OR): 1.022; 95% confidence interval (CI): 0.998-1.047; p = 0.07] and K-cars (OR: 3.708; 95% CI: 0.984-6.236; p = 0.05) tended to be associated with bowel/mesentery injuries in restrained drivers. The frequency of pelvic/hip fractures also tended to be higher in K-car drivers than in standard vehicle drivers (5.9% vs. 2.6%; p = 0.10). By contrast, the severity and frequency of the upper torso injuries were similar between the two groups. CONCLUSIONS: Compared to standard vehicle drivers, K-car drivers seem to experience more severe bodily injuries after severe RTAs. Despite there being no answer for the increased frequency of only hollow viscus injuries but not solid viscus injuries among restrained K-car drivers, advanced age may, at least in part, be responsible. Given the limitations inherent to this study's single-center, retrospective design, multi-center prospective studies are warranted to verify our findings.
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日本腹部救急医学会雑誌 38(6) 1075-1079 2018年9月 査読有り症例は44歳の男性が心窩部痛、呼吸困難を主訴に当院に救急搬送された。来院時ショック状態、胸腹部造影CT検査から下膵十二指腸動脈瘤破裂による腹腔内出血の診断に至った。動脈瘤はsegmental arterial mediolysis(以下、SAM)と臨床的に診断した。大動脈遮断バルーンを挿入し、血管塞栓術を施行した。治療終了直後より腹部膨満を認め、再び循環動態不安定となった。腹部コンパートメント症候群(abdominal compartment syndrome、以下ACS)の診断で、開腹減圧術、開腹管理を施行し、循環動態の安定が得られた。腹腔内出血の治療として血管塞栓術による治療症例が多数報告されているが、血管塞栓術で動脈性出血が制御できた症例であっても、本例のようにACSに至る可能性が懸念される。腹腔内圧や臓器障害の程度を評価し、ACSと判断した場合には迅速に開腹減圧術を考慮することが肝要である。(著者抄録)
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World Journal of Emergency Surgery 31(11) 45 2016年8月 査読有りBackground: Live tissue models are considered the most useful simulation for training in the management for hemostasis of penetrating injuries. However, these models are expensive, with limited opportunities for repetitive training. Ex-vivo models using tissue and a fluid pump are less expensive, allow repetitive training and respect ethical principles in animal research. The purpose of this study is to objectively evaluate the effectiveness of ex-vivo training with a pump, compared to live animal model training. Staff surgeons and residents were divided into live tissue training and ex-vivo training groups. Training in the management of a penetrating cardiac injury was conducted for each group, separately. One week later, all participants were formally evaluated in the management of a penetrating cardiac injury in a live animal. Results: There are no differences between the two groups regarding average years of experience or previous trauma surgery experience. All participants achieved hemostasis, with no difference between the two groups in the Global Rating Scale score (ex-vivo: 25.2 +/- 6.3, live: 24.7 +/- 6.3, p = 0.646), blood loss (1.6 +/- 0.7, 2.0 +/- 0.6, p = 0.051), checklist score (3.7 +/- 0.6, 3.6 +/- 0.9, p = 0.189), or time required for repair (101 s +/- 31, 107 s +/- 15, p = 0.163), except overall evaluation (3.8 +/- 0.9, 3.4 +/- 0.9, p = 0.037). The internal consistency reliability and inter-rater reliability in the Global Rating Scale were excellent (0.966 and 0.953 / 0.719 and 0.784, respectively), and for the checklist were moderate (0.570 and 0.636 / 0.651 and 0.607, respectively). The validity is rated good for both the Global Rating Scale (Residents: 21.7 +/- 5.6, Staff: 28.9 +/- 4.7, p = 0.000) and checklist (Residents: 3.4 +/- 0.9, Staff Surgeons: 3.9 +/- 0. 3, p = 0.003). The results of self-assessment questionnaires were similarly high (4.2-4.9) with scores in self-efficacy increased after training (pre: 1.7 +/- 0.8, post: 3.2 +/- 1.0, p = 0.000 in ex-vivo, pre: 1.9 +/- 1.0, post: 3.7 +/- 0.7, p = 0.000 in live). Scores comparing pre-training and post-evaluation (pre: 1.7 +/- 0.8, post: 3.7 +/- 0.9, p = 0.000 in ex-vivo, pre: 1.9 +/- 1.0, post: 3.8 +/- 0.7, p = 0.000 in live) were increased. Conclusion: Training with an ex-vivo model and live tissue training are similar for the management of a penetrating cardiac injury, with increased self-efficacy of participants in both groups. The ex-vivo model is useful to learn hemostatic skills in trauma surgery.
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Acute Medicine & Surgery. 28(3(4)) 305-309 2016年3月 査読有り筆頭著者
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医学教育 46(6) 497-502 2015年12月 査読有り筆頭著者
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World journal of emergency surgery : WJES 10 61-61 2015年BACKGROUND: To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression. METHODS: The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study. RESULTS: Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p < 0.0001). The multivariate logistic regression model was highly significant (p < 0.0001, R2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4. CONCLUSIONS: WSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.
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Japanese Journal of Acute Care Surgery 4(2) 193-193 2014年9月
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World journal of emergency surgery : WJES 9 37-37 2014年The CIAOW study (Complicated intra-abdominal infections worldwide observational study) is a multicenter observational study underwent in 68 medical institutions worldwide during a six-month study period (October 2012-March 2013). The study included patients older than 18 years undergoing surgery or interventional drainage to address complicated intra-abdominal infections (IAIs). 1898 patients with a mean age of 51.6 years (range 18-99) were enrolled in the study. 777 patients (41%) were women and 1,121 (59%) were men. Among these patients, 1,645 (86.7%) were affected by community-acquired IAIs while the remaining 253 (13.3%) suffered from healthcare-associated infections. Intraperitoneal specimens were collected from 1,190 (62.7%) of the enrolled patients. 827 patients (43.6%) were affected by generalized peritonitis while 1071 (56.4%) suffered from localized peritonitis or abscesses. The overall mortality rate was 10.5% (199/1898). According to stepwise multivariate analysis (PR = 0.005 and PE = 0.001), several criteria were found to be independent variables predictive of mortality, including patient age (OR = 1.1; 95%CI = 1.0-1.1; p < 0.0001), the presence of small bowel perforation (OR = 2.8; 95%CI = 1.5-5.3; p < 0.0001), a delayed initial intervention (a delay exceeding 24 hours) (OR = 1.8; 95%CI = 1.5-3.7; p < 0.0001), ICU admission (OR = 5.9; 95%CI = 3.6-9.5; p < 0.0001) and patient immunosuppression (OR = 3.8; 95%CI = 2.1-6.7; p < 0.0001).
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日本救急医学会雑誌 24(8) 494-494 2013年8月
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World Journal of Emergency Surgery 9(7) 5 2012年3月 査読有りSurgical residents have insufficient opportunites to learn basic hemostatic skills from clinical experience alone. We designed an ex-vivo training system using porcine organs and a circulation pump to teach hemostatic skills. Residents were surveyed before and after the training and showed significant improvement in their self-confidence (1.83 +/- 1.05 vs 3.33 +/- 0.87, P < 0.01) on a 5 point Likert scale. This training may be effective to educate residents in basic hemostatic skills.
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日本臨床外科学会雑誌 64(9) 2203-2206 2003年9月 査読有り65歳女.右下腹部痛と発熱が出現し,近医にて投薬を受けるも改善しなかった.入院時,39.5℃,右下腹部に軽度圧痛を認め,WBC,CRP,LDH軽度上昇と軽度貧血を認め,急性虫垂炎と診断した.腹部所見は軽度であり,症状は保存的治療にて一旦軽快したが,経口摂取開始後に再燃した.腹部ヘリカルCTでは盲腸を中心に造影効果が強く,その内側に虫垂と思われる管腔構造を認め,白血球数も上昇したため,手術を行った.虫垂根部は炎症が強く,盲腸壁は硬く腫瘤状であり,悪性疾患も疑い回盲部切除術を施行した.術後,腹部症状は改善したが,白血球数は漸増して異常高値を示し,末梢血中に芽球を認め,病理組織には虫垂壁全体から盲腸壁まで白血病細胞のび漫性浸潤像を認めた.骨髄生検により急性骨髄性白血病M2と確定診断し,転院して化学療法が行われ寛解した.本例は虫垂根部に白血病細胞浸潤による閉塞機転が生じ急性虫垂炎を惹起したと推測された
MISC
41書籍等出版物
8講演・口頭発表等
16-
20th European Congress of Trauma & Emergency Surgery. 2019年5月7日
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19th European Congress of Trauma & Emergency Surgery. 2018年5月7日
所属学協会
5共同研究・競争的資金等の研究課題
11-
日本学術振興会 科学研究費助成事業 2022年4月 - 2027年3月
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日本学術振興会 科学研究費助成事業 2023年4月 - 2026年3月
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日本学術振興会 科学研究費助成事業 2022年4月 - 2025年3月
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日本学術振興会 科学研究費助成事業 2021年4月 - 2025年3月
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日本学術振興会 科学研究費助成事業 若手研究 2020年4月 - 2023年3月