Explore the vast range of titles available.

An obese middle-aged man presented for left abdominal pain. CT scan with contrast medium revealed hematoma in the left abdominal internal oblique muscle.An obese middle-aged man presented for left abdominal pain. CT scan with contrast medium revealed hematoma in the left abdominal internal oblique muscle.

We report a case of severe acute respiratory syndrome coronavirus 2 and Legionella co-infection manifesting as pneumonia with gastrointestinal symptoms. The case highlights the importance of differential diagnosis during the COVID-19 pandemic, so we do not miss the opportunity to diagnose other treatable causes of disease with similar symptoms.

Background Cardiopulmonary resuscitation is essential for cardiopulmonary arrest, but complications from chest compressions warrant monitoring. Although rib and sternal fractures are common, abdominal injuries are rare, and splenic injuries are much rarer. Case Presentation A 74‐year‐old man was admitted to the emergency room with a hemorrhagic duodenal ulcer. During hospitalization, the patient went into cardiopulmonary arrest due to hemorrhagic shock. Spontaneous circulation returned after 7 min of cardiopulmonary resuscitation. He underwent transcatheter arterial embolization to stop the bleeding from the duodenal ulcer. The next day, a close examination of the patient's progressive anemia revealed splenic injury; transcatheter arterial embolization was performed to save his life. Conclusion It is important to consider the complication of splenic injury in patients with cardiopulmonary arrest who have undergone appropriate cardiopulmonary resuscitation. A possible mechanism—especially in patients with a full stomach—is the squeezing of the spleen by the diaphragm, abdominal wall, and stomach. Following cardiopulmonary resuscitation for in‐hospital cardiac arrest due to duodenal ulcer bleeding, transcatheter arterial embolization was performed to halt bleeding. Subsequently, splenic hemorrhage was identified, and splenic artery embolization followed.

Background We describe a case of segmental arterial mediolysis in which a vessel ruptured on two consecutive days. Case Presentation A 69‐year‐old man presented with sudden‐onset abdominal pain. Computed tomography showed a hematoma in the gastric wall. The patient was discharged after the pain was relieved but returned 8 h later with abdominal pain and shock. Repeated computed tomography revealed a massive intra‐abdominal hemorrhage without previous aneurysm formation. Emergency angiography and coil embolization were successfully carried out. Segmental arterial mediolysis was diagnosed after irregular vasodilated lesions were observed in multiple arteries. Conclusion This case suggests that accurately predicting the next vessel rupture is difficult. For patients experiencing intra‐abdominal bleeding with segmental arterial mediolysis, we suggest treating only ruptured aneurysms and closely following‐up unruptured aneurysms. We describe a case of segmental arterial mediolysis with a vessel ruptured on two consecutive days.

Background Heat stroke treatment focuses on rapid cooling because symptom severity correlates with the duration of hyperthermia (i.e., time during which the core body temperature is sustained above the critical threshold). Several reports have revealed that cold‐water immersion is a safe and appropriate therapy for exertional heat stroke in young, otherwise healthy patients. However, few reports have assessed cold‐water immersion in older patients. We document three cases of cold‐water immersion in older heat stroke patients and evaluate its safety and efficacy. Case presentation Three older patients with severe heat stroke were treated with cold‐water immersion. Core body temperatures decreased rapidly, and no complications occurred during the treatment. Conclusion Cold‐water immersion can achieve rapid cooling and is effective in treating heat stroke. With special precautions, it can be performed safely for older patients. Further investigation is warranted to establish appropriate cooling methods in older adults. Safety and efficacy of cold‐water immersion in the treatment of older patients with heat stroke.

Aim Sepsis treatment has been standardized in many countries worldwide. However, treatment of sepsis in Japan has developed independently, and how Japanese physicians actually treat sepsis patients nationwide remains uninvestigated. The aim of this study was to clarify the current practice for septic patients in Japan and how it differs from standard care throughout the world. Methods This study was designed as a prospective, cross‐sectional, self‐reported questionnaire‐ and Web‐based electronic survey in Japan. The survey was undertaken to assess respondents’ clinical practices and preferences regarding treatment strategies, sepsis assessment, and management in the setting of critical illness. An exploratory factor analysis and a hierarchical cluster analysis were carried out to identify the treatments distinctive to Japan, called “Galápagos therapies”. Results The final analysis included 295 respondents. According to the factor analysis, we defined anticoagulant therapy for disseminated intravascular coagulation, antimediator renal replacement therapy, and others as Galápagos therapies. These Galápagos therapies were undertaken by approximately two‐thirds of the Japanese physicians who responded. We classified Japanese physicians according to three patterns of clinical practice carried out for sepsis: (i) those who do not perform Galápagos therapies but do perform worldwide standardized care, (ii) those who perform Galápagos therapies on top of worldwide standardized care, (iii) those who do not perform worldwide standardized care. Conclusion On the basis of a nationwide questionnaire‐based survey in Japan, we clarified distinctive sepsis treatments performed in Japan, such as antimediator renal replacement therapy and treatment for sepsis‐induced disseminated intravascular coagulation. On the basis of a nationwide questionnaire‐based survey in Japan, we clarified distinctive sepsis treatments performed in Japan, such as antimediator renal replacement therapy and sepsis‐induced disseminated intravascular coagulation treatment. In this article, we defined them as Galápagos therapies and advocate their unique clinical concept; however, evaluation of the effectiveness of the Galápagos therapies will require a detailed analysis of the data on a patient level.

A previously healthy 86-year-old woman presented to the ED with sudden-onset pain and bruising in her left thumb, beginning several hours before. She denied any history of trauma or cold exposure. Her vital signs were stable. Physical examination revealed a subcutaneous haematoma and swelling with a normal sensation. D-dimer levels were not elevated (figure 1).

We constructed sugi site index models using digital-terrain-analysis-based environmental factors for Miyazaki Prefecture. We selected 18 sugi plantation stands which were pure, undisturbed, and over 40 years old, planted with the same sugi-cutting cultivar, and managed by normal forest operations. The dominant tree in each stand was felled for stem analysis. Site index, defined here as dominant tree height at 40 years old, was estimated by stem analysis for each stand. Five types of DEMs were used: 100- and 50-m resolution derived from DEMs published by the Geographical Survey Institute, and 50-, 25-, and 12.5-m resolution derived from digital contour map manually generated from a 1:25,000 topographic map. A total of 14 indices categorized into solar radiation index, wetness index, and topographic exposure index were used to model the site index by multiple linear regression analysis. Through model selection procedures, the best-fitted site index models were selected for each type of DEM. The most precise model was that of the 12.5-m-resolution DEM (R 2 = 0.692), following the model of the published 50-m-resolution DEM (R 2 = 0.665). Site productivity of sugi was severely limited by direct solar radiation. Soil wetness also affected sugi site productivity; however, it can only be represented using a high-resolution DEM derived from fine-scale data. Our results suggest that the 50-m-resolution DEM published by the Geographical Survey Institute can be used for site index modeling.