Journal of Nippon Medical School = Nippon Ika Daigaku zasshi
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More than 6,000 people died in the Great Hanshin (Kobe) Earthquake in 1995, and it was later reported that there were around 500 preventable trauma deaths. In response, the Japanese government developed the helicopter emergency medical service in 2001, known in Japan as the "Doctor-Heli" (DH), which had 46 DHs and 2 private medical helicopters as of April 2016. DHs transport physicians and nurses to provide pre-hospital medical care at the scene of medical emergencies. ⋯ Aeromedical transport by DHs and helicopters belonging to several other organizations was accomplished smoothly because the commanders of the involved organizations could communicate directly with each other in person within the Aviation Coordination Section of the prefectural government office. However, ongoing challenges in the detailed operating methods for aeromedical transport were highlighted and include improving shared knowledge and training across the organizational framework. These are particularly important issues to address given the Nankai Trough and Tokyo inland earthquakes that are predicted for the near future in Japan.
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The purpose of this study was to evaluate mid- and long-term clinical and radiologic outcomes of arthroscopic coracoclavicular ligament reconstruction (ACCLR) with an artificial ligament for acute dislocation of the acromioclavicular joint (ACJ). ⋯ ACCLR for acute dislocation of the ACJ is a useful surgical procedure that gives satisfactory clinical and radiologic outcomes on mid- and long-term follow-up. ACCLR can stabilize vertical instability of the ACJ. If instability in the horizontal direction remains, repair or reconstruction of the acromioclavicular ligament should be added to prevent osteoarthritic changes of the ACJ.
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Incisional surgical site infection (SSI) is a leading complication of stoma reversal procedures. This retrospective study was conducted to assess the incidence of incisional SSI and other wound complications when wound closure was achieved by subcuticular suturing and closed suction drainage following stoma reversal. We analyzed data from a total of 49 patients, all of whom had undergone insertion of a 10 Fr closed suction drainage tube in the fascia, following irrigation with approximately 300 mL of physiological saline. ⋯ No wound disruptions, seromas, or drain infections were evident. Our data are reliable, but our study is limited in terms of general applicability; however, the low SSI rate indicates that the procedure is acceptable. Further research into this procedure will require a randomized trial design.
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The aim of this study was to identify a useful biomarker to predict the efficacy of polymyxin B-immobilized fiber direct hemoperfusion (PMX-DHP) in patients with septic shock. ⋯ S1P levels prior to PMX-DHP can be used to predict its efficacy. In addition, continuous monitoring of S1P levels can indicate the effectiveness of PMX-DHP in patients with septic shock.
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Case Reports
Irreducible Elbow Fracture and Dislocation due to Incarceration of the Medial Epicondyle of the Humerus in a Child.
Medial epicondyle fractures of the humerus account for 11%-20% of all elbow injuries in children. Although intra-articular incarceration of the medial epicondyle occurs in 5%-18% of medial epicondyle fractures associated with an elbow dislocation, the mechanism of intrusion of the fracture fragment is unknown. We report a case of an irreducible elbow fracture and dislocation due to incarceration of the medial epicondyle fragment of the humerus, classified as a Watson-Jones type 3 fracture of the medial epicondyle, and present the mechanism of the intra-articular incarceration of the medial epicondyle fragment. ⋯ After 30 months he was asymptomatic and able to perform all of his daily life activities without any limitation. Our case, a Watson-Jones type 3 medial epicondyle fracture, is suggestive of the mechanism of incarceration of the medial epicondyle fragment into the elbow joint. Our findings support the idea that the attachment of both the MCL and the articular capsule can result in the entrapment of a fracture fragment in the elbow joint.