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Purpose: Blunt thoracic aortic injury (BTAI) has a high mortality rate, and the occurrence of clinical complications is high. Several studies have reported the efficacy of thoracic endovascular aortic repair (TEVAR) for BTAI. This study aimed to clarify the use of TEVAR for BTAI., Methods: We analyzed 10 cases of TEVAR for BTAI from July 2011 to December 2020 at our hospital. Five of 10 cases of BTAI were caused by road traffic accidents, while five were caused by falls from a height., Results: The mean patient age was 59.3 years. When arriving at our hospital, seven of 10 patients were in shock. Nine of 10 cases of BTAI were at the aortic isthmus. With respect to BTAI severity, five of 10 patients were categorized as grade IV. Ps of non-survivors were extremely low. All patients underwent TEVAR. The mean surgical duration and volume of intraoperative blood loss were 77.5 minutes and 234 ml, respectively., Conclusion: The results of TEVAR for BTAI at our institution support previous reports, which show excellent clinical results. To further improve the outcomes, we must clarify the adaptation of nonoperative management (delayed repair), the optimal timing of invasive treatment, and the importance of long-term follow-up.

Double inversion-recovery (DIR) imaging has the potential to improve the detection of subcortical lesions through the use of voxel-based morphometry (VBM) analysis. The aim of this study was to clarify the characteristics of detectable lesions by performing a VBM analysis on DIR images of simulated lesions. Twenty healthy volunteers underwent magnetic resonance imaging using a head three-dimensional DIR sequence. The images were processed using SPM12; then, the selected images with simulated lesions were analyzed via VBM. The VBM results were evaluated using free-response receiver-operating characteristic curves and a receiver-operating characteristic analysis. The sensitivity was 100% (5/5), with 5.6 false-positive objects per case, in simulated lesions with a contrast of 0.6 and a size of 2.4 mm. The sensitivity was 80% (4/5), with 5.4 false-positive objects per case, in simulated lesions with a contrast of 0.5 and a size of 2.4 mm. The mean area under the curve value was increased from 0.783 to 0.883 using VBM, with a statistically significant difference (p < 0.01). The VBM analysis of the DIR images using SPM alone showed the potential to detect subcortical microscopic lesions. Early detection of Alzheimer's disease may be possible by adapting VBM in the clinical setting.

A 67-year-old man suffered a traffic accident and was transferred to an emergency hospital close to the scene. He was diagnosed to have bilateral pneumohemothorax with a lung contusion, an anterior fracture dislocation of the C6-vertebra and a cervical cord injury at the level of C7. On the 48th day, massive hemoptysis was suddenly recognized. He was transferred in a state of shock to our hospital to undergo hemostasis for the bleeding. On the day of admission, a selective arteriogram showed extravasation from the left bronchial artery, for which embolization was carried out using Gelfoam. In spite of this treatment, his hemoptysis continued. On the next day, a selective left internal mammary arteriogram showed an arteriovenous fistula between the left internal mammary artery and the left pulmonary vein without any apparent extravasation. The arteriovenous fistula was successfully embolized using platinum fiber coils. The patient no longer demonstrated any hemoptysis after embolization.

Objective: The purpose of this study was to examine whether microwave tissue coagulation (MTC) therapy is capable of stopping bleeding from severe liver injury in pigs., Methods: Ten pigs (38 +/- 4 kg) underwent a 30-mL/kg isovolemic exchange transfusion with 3% low-molecular-weight dextran to produce dilutional coagulopathy, and then a through-and-through laceration injury measuring approximately 8 cm in length was induced in the right hepatic lobe. Immediately after inflicting the injury, the animals were randomly divided into two groups: Group A (n = 5, MTC was repeated along the liver laceration at intervals of 2.0 cm with manual compression) or Group B (n = 5, the injured lobe was manually compressed without MTC therapy for 1 minute). All animals received lactated Ringer's solution to maintain the mean arterial pressure at 75 mm Hg for 1 hour after the abdominal closure. The intraperitoneal blood loss, mean arterial pressure, volume of lactated Ringer's solution, and hematologic variables were compared between the groups. For further laboratory evaluation, three additional experimental animals were treated with the MTC therapy after inflicting the injury and then were allowed to survive for 14 days., Results: Mean arterial pressure declined from a mean value of 88 +/- 10 mm Hg (range, 75-107 mm Hg) to 62 +/- 3 mm Hg (range, 50-75 mm Hg) after the induction of liver injury. The total blood loss in Group A was 192 +/- 58 g (range, 120-250 g), which was lower (p < 0.01) than that of 448 +/- 138 g (range, 260-650 g) in Group B. The resuscitation fluid volume of Group A animals was 304 +/- 204 mL (range, 100-600 mL), which was smaller (p < 0.01) than that of 1,320 +/- 654 mL (range, 900-2,250 mL) in Group B. At 14 days, all three animals that were treated in the additional study were found to be in good health. Their necropsies showed no evidence of an intrahepatic abscess, hematoma, or biloma., Conclusion: MTC therapy was thus found to provide simple, rapid, and definitive hemorrhage control in cases of severe liver injury without the need for reoperation.

Objective: To examine whether induced hypothermia could prolong short-term survival after volume-controlled hemorrhagic shock (HS)., Materials and Methods: Fifteen pigs with systemic heparin underwent blood withdrawal of 30 ml/kg over 15 min under spontaneous breathing with halothane anesthesia. The pigs were divided into three groups of five pigs each: Group 1, hemorrhage plus hypothermia with extracorporeal shunt circulation (ECSC); Group 2, hemorrhage plus normothermia with ECSC; and Group 3, hemorrhage alone. For Groups 1 and 2, arteriovenous ECSC was performed for 20 min during HS. The re-infused shunt blood was cooled down to approximately 15 degrees C in Group 1, whereas it was returned at 37.5 degrees C in Group 2. The pigs in Group 3 had no ECSC and were left at room temperature. All pigs were observed until their death or for a maximum of 240 min., Results: The mean pulmonary artery temperature (T(pa)) of Group 1 animals decreased to 34.5 degrees C at 15 min after the initiation of ECSC, and thereafter remained at 35.5 degrees C after undergoing ECSC. The T(pa) values for Groups 2 and 3 animals remained at 37.5 degrees C throughout the experiment. All five pigs in Group 1 survived until 240 min, whereas all pigs in Group 2 and 3 of five pigs in Group 3 died before 215 min after blood withdrawal. A life table analysis revealed significantly increased survival in Group 1 compared with Group 2 (P<0.01) and Group 3 (P<0.05)., Conclusions: In lightly anesthetized pigs during volume-controlled HS, induced hypothermia may prolong their short-term survival for reasons that remain to be clarified.

The effectiveness of early-phase dynamic spiral computed tomography (CT) of the whole body for screening multiple trauma was compared with that of conventional incremental CT. Thirty-six patients with suspected blunt hemorrhagic injuries were prospectively assigned to undergo either standard uniphasic incremental CT or spiral CT enhanced during the early arterial phase. In comparison with incremental CT, the wider scan coverage in spiral CT resulted in the detection of more injuries. Spiral CT showed an excellent enhancement of both the arteries and parenchyma with a reduced volume of contrast material, however, more contrast artifacts were observed. All extravasations detected in spiral CT were from the arteries and required subsequent interventions including transcatheter embolization. Primary screening with early-phase dynamic spiral CT for hemorrhagic multiple trauma was found to be useful for determining the applications of subsequent angiographic intervention as well as evaluating lesions caused by injury., (Copyright 2002, Elsevier Science (USA).)

Objective: To test our hypothesis that during lethal uncontrolled hemorrhagic shock (UHS) in rats, mild hypothermia of either 36 or 34 degrees C would prolong the survival time in comparison with normotherma of 38 degrees C., Methods: Twenty-four rats were lightly anesthetized with halothane and maintained spontaneous breathing. UHS was induced by blood withdrawal of 2.5 ml/100 g over 15 min, followed by 75% tail amputation. Immediately after the tail cut, the rats were randomly divided into three groups (eight rats for each); normothermic Group 1 (control, rectal temperature 38 degrees C), and mild hypothermic Groups 2 (36 degrees C) and 3 (34 degrees C). Hypothermia was induced and maintained by body surface cooling. The rats were then observed without fluid resuscitation until their death (apnea and no pulse) or for a period of 240 min maximum., Results: The rectal temperature was cooled down to 36 and 34 degrees C in 5 and 10 min, respectively. The mean survival time, which was 76+/-26 min in the control group (38 degrees C), was nearly doubled by mild hypothermia, 178+/-65 min for Group 2 (36 degrees C) (P<0.01 vs. control) and 144+/-54 min for Group 3 (34 degrees C) (P<0.05 vs. control) (no significant difference between Group 2 and 3). Additional blood losses from tail stumps were not significantly different among the three groups., Conclusion: Mild hypothermia of either 36 or 34 degrees C prolongs the survival time during lethal UHS in rats.

Objective: The purpose of this study was to examine whether cold fluid infusion could rapidly decrease the core temperature and prolong survival during uncontrolled hemorrhagic shock in pigs., Methods: Fourteen pigs under light halothane anesthesia and spontaneous breathing underwent initial blood withdrawal of 25 mL/kg over 15 minutes, followed by uncontrolled hemorrhage (5-mm aortotomy). Immediately after the aortotomy, the pigs were randomized to receive 500 mL lactated Ringer's solution at either 4 degrees C (group 1, n = 7) or 37 degrees C (group 2, n = 7) over 20 minutes through the internal jugular vein and observed until their death or for a maximum of 240 minutes., Results: The pulmonary artery temperature of group 1 decreased to 35.5 degrees +/- 0.3 degrees C after the infusion, then remained at 35.5 degrees C during the observation period. Pulmonary artery temperature values of group 2 remained at around 37.5 degrees C throughout the experiment. The mean survival time was 220 +/- 45 minutes in group 1 versus 136 +/- 64 minutes in group 2 (p < 0.05, life table analysis). The additional intraperitoneal blood loss of group 1 was similar to that of group 2 (9 +/- 4 g/kg vs. 10 +/- 5 g/kg)., Conclusion: In lightly anesthetized pigs during uncontrolled hemorrhagic shock, infusion with 4 degrees C lactated Ringer's solution (which seems to be feasible in the clinical setting) decreases the core temperature rapidly and prolongs survival.

The aim of this study is to examine the characteristics of nitrite/nitrate (NOx), the final metabolite of nitric oxides, in plasma after burn injury. A total of 83 blood samples were collected from 19 patients on arrival, day 1, day 3, and day 5 after suffering burn injuries and from 7 non-burned volunteers. We measured the NOx levels in plasma using the Griess method, and analyzed the relationships among plasma the NOx levels, the burn-magnitude, and the blood examination data using a stepwise multivariate regression analysis. The plasma NOx levels at hospital-arrival after burns significantly exceeded those of non-burned volunteers, and the NOx levels in the plasma returned to normal range after day 1. Based on the findings of a multivariate analysis, the plasma NOx levels at admission to the hospital were not found to be related to the total burn surface area, the burn index or inhalation injury, but they were significantly related to age. Furthermore, these plasma NOx levels were also related to the platelet count, neutrophil count and blood urea nitrogen. The increase in the plasma NOx level may therefore play an important role in the pathophysiology of elderly burned patients, while the nitric oxide levels in the plasma might also play a role in inhibiting the constriction of microvascular smooth muscle in extensively burned patients.