PurposeSuccessful cardiopulmonary resuscitation is associated with a high incidence of chest wall injuries. However, few studies have examined chest wall injury as a risk factor for respiratory ...complications after cardiopulmonary resuscitation. Therefore, herein, we investigated the association of multiple rib fractures on the incidence of post-resuscitation pneumonia. MethodsThis single-centre retrospective cohort study enrolled adult, nontraumatic, out-of-hospital cardiac arrest patients who maintained circulation for more than 48 h between June 2015 and May 2019. Rib fractures were evaluated by computed tomography on the day of hospital admission. The association with newly developed pneumonia within 7 days of hospitalisation was analysed using a Fine-Gray proportional hazards regression model adjusted for the propensity score of multiple rib fractures estimated from age, sex, presence of witnessed status, bystander CPR, initial rhythm, and total CPR time and for previously reported risk factors for pneumonia (therapeutic hypothermia and prophylactic antibiotics). ResultsOverall, 683 patients with out-of-hospital cardiac arrest were treated; 87 eligible cases were enrolled for analysis. Thirty-two (36.8%) patients had multiple rib fractures identified on computed tomography, and 35 (40.2%) patients developed pneumonia. The presence of multiple rib fractures was significantly associated with a higher incidence of pneumonia, consistently both with and without adjustment for background factors (unadjusted hazard ratio 4.63, 95% confidence interval: 2.35-9.13, p < 0.001; adjusted hazard ratio 4.03, 95% confidence interval: 2.08-7.82, p < 0.001). ConclusionsMultiple rib fractures are independently associated with the development of pneumonia after successful resuscitation.
Unstable sacral fractures are high-energy injuries and comprise polytrauma. Internal fixation to enable withstanding vertical loads is required to get up early from the bed after an unstable sacral ...fracture. We developed a new minimally invasive surgical (MIS) procedure for unstable pelvic ring fractures and reported it in Japanese in 2010. We presented our minimally invasive surgical technique of crab-shaped fixation for the treatment of unstable pelvic ring fractures and report on its short-term outcomes.
Sixteen patients with unstable pelvic ring fractures (AO types C1, 2, and 3) were treated using crab-shaped fixation. All procedures were performed with the patient in the prone position through 5-cm skin incisions created bilaterally at the level of the posterior superior iliac spine. Four iliac screws were inserted and connected with two rods under the fascia. Percutaneous pedicle screws were inserted at L5 or L4 and connected to the iliac rod using offset connectors. Fracture reduction was then performed.
The average surgical time was 158 min (range, 117-230 min), with an intraoperative bleeding volume of 299 ml (range, 80-480 ml). Thirty-three pedicle screws and 64 iliac screws were implanted with no instance of malpositioning or perforation. A surgical site infection developed in 2 of the 16 cases. Both were deep methicillin-resistant Staphylococcus aureus infections, with the removal of the distal implants required in only one of these cases. Bony union was achieved in all patients, and all vertical displacements reduced by 7.0 mm, on average (range, 5.4-9.0 mm), to < 10 cm. Correction was retained in all cases.
Crab-shaped fixation provides a feasible MIS approach for spinopelvic fixation, which allows good reduction of the vertical displacement of unstable pelvic ring fractures and bony union.
•In cases of severe consciousness disorder with head injury, it is difficult to diagnose consciousness disorder due to VAI from cervical spine trauma because of insufficient physical and neurological ...findings.•We reported the case of a patient with extensive brain infarctions because of bilateral VAI without any remarkable CT findings suggestive of VAI.•When cervical hyperextension injury is suspected, CTA should be performed as early as possible to initiate early treatment of extensive brain infarction due to bilateral VAI.
Vertebral artery injury (VAI) is not uncommon following blunt neck trauma, although bilateral VAI—which is rarer—can be fatal. We present the case of a 77-year-old man who was transported with a head injury and consciousness disorder. No hemorrhagic lesions in the patient’s head were noted using computed tomography (CT). Mild anterior opening between the fourth and fifth cervical vertebrae (C4 and C5) and multiple spinous process fractures between C4 and the first thoracic vertebrae (T1) were detected. No CT findings suggestive of VAI were noted. Brain magnetic resonance imaging (MRI) findings showed extensive brain infarctions, bilateral VAI, anterior longitudinal ligament injury, disc injury at C4/5, and retropharyngeal hematoma. He was admitted to the intensive care unit, but his family refused invasive surgical treatment; he died 6 days after admission. The extensive brain infarctions were considered to be associated with bilateral VAI because of cervical hyperextension injury. This case highlighted the importance of considering brain ischemia due to VAI, as a differential diagnosis, in patients with consciousness disorder and possible cervical hyperextension injuries, even in the absence of CT findings suggestive of VAI. In such patients, CT angiography should be performed early to evaluate the possibility of VAI.
•Extensive burn patients rarely suffer from hypercalcemia.•A dressing material containing calcium alginate fibers can cause hypercalcemia in severe burn patients.•Immediate removal of the dressing ...form can decrease blood calcium levels.
Due to abnormalities in bone metabolism and an inability to produce normal vitamin D levels in the skin, patients with extensive burns often present with hypocalcemia, not hypercalcemia. In this report, we present a rare case of acute hypercalcemia caused by silver-containing calcium alginate fibers as a dressing in a patient with extensive burn injury. The patient had been treated with oral calcium formulation because of hypocalcemia. We applied silver-containing calcium alginate fibers to raw surface area after the first skin grafting surgery, and the calcium level corrected for the serum albumin level continued to rise up to 15.4 mg/dl with this dressing form even after discontinuation of oral calcium preparations. Cessation of the use of this dressing resulted in a sharp drop in blood calcium levels. Therefore, we concluded that the cause of the hypercalcemia was the absorption of calcium ions eluted from the silver-containing calcium alginate fibers. Our findings suggest that dressings may cause hypercalcemia in patients with extensive burns, and that physicians should be attentive to the dressings used in burn wound care.
We present the case of a 79-year-old woman who presented at our center with a periprosthetic tibial fracture with a popliteal artery injury after total knee arthroplasty. Anastomosis of the popliteal ...artery was performed on the day of injury, and was later treated by open reduction and internal fixation. The patient was able to walk 3 months after injury.
The present case was difficult to treat because of the arterial injury associated with periprosthetic fracture. Although revision of the implant was considered, open reduction and internal fixation was selected because of the severity of soft-tissue damage. The mechanism of injury is not uncommon, and it is expected that similar fractures will become more prevalent in the future as the number of knee replacement surgeries increases.
•We experienced a case of periprosthetic tibial fracture after total knee arthroplasty with popliteal artery injury.•There have been no reports of periprosthetic fracture associated with popliteal artery injury.•Because this injury process is not specific, the chances of encountering this injury are expected to increase in the future.
A 54-year-old male patient diagnosed with hepatorenal syndrome caused by decompensated alcoholic cirrhosis was referred for arteriovenous fistula (AVF) creation after initiation of hemodialysis. A ...brachiobasilic arteriovenous fistula (BBAVF) was created because neither forearm had suitable vasculature. Large-volume serous effusion from the incision persisted postoperatively, and we started negative pressure wound therapy (NPWT) for wound protection. The effusion volume decreased gradually; however, up to 80 ml of discharge continued daily. Re-operation was performed 35 days after the initial operation, followed by continued NPWT. The wound was almost healed 85 days after the primary surgery. We present a case of severe surgical wound complication after AVF creation in a patient with hemostatic and coagulation disorders and malnutrition caused by end-stage hepatic failure. We confirmed the usefulness of NPWT for excessive surgical wound effusion and the adequacy of BBAVF for vascular access.
We prepare two layers organic light-emitting diodes (OLED) composed of small molecular materials. Organic multilayers are accumulated by spin-coat method on polyethylene terephthalate/indium-tin ...oxide (PET/ITO) substrate. The multilayer is investigated by measurement of current density as a function of applied voltage at three different positions. Among these points, at the one farthest from the rotating center in the spin-coat process, the largest current density of 1.1 mA/cm2 is observed under a bias voltage of 20 V. For this point linear relationship in lnJ versus V1/2 and lnJ/V versus V1/2 indicate that the electronic conduction originates from Schottky and a hopping mechanism of carriers. At the other positions, where film thickness is thinner, tunneling current is expected.
This report presents a case of adrenal injury with active bleeding that was treated using gauze packing. A 21-year-old man who had been involved in a motor vehicle accident was transferred to our ...hospital. Abdominal contrast-enhanced computed tomography revealed lung injuries, liver injuries, right renal injury, and adrenal injury with active bleeding ; therefore, an emergency laparotomy was performed. The retroperitoneal pressure suppressed the bleeding due to the adrenal injury. However, dissection into the retroperitoneum to repair the renal injury resulted in loss of the compressive effect of the adjacent structures ; therefore, the adrenal injury had to be repaired along with the hepatic injury. Gauze packing was effective, and aortography did not reveal any extravasation. The findings of this case, suggest that gauze packing should be considered for treating adrenal injury with active bleeding, especially in cases in which open surgery is performed before angiography.
A new highly active low-valent alkoxyniobium species has been developed following the reaction of Nb(OEt)5 with Grignard reagent such as i-PrMgCl or EtMgCl, with the material behaving as an efficient ...catalyst for cyclotrimerization reaction of isocyanates. In this reagent system, the existence of a low-valent niobium species was confirmed by the formation of the niobium–alkyne complex prepared from the Nb(OEt)5/Grignard reagent system and an alkyne. Furthermore, the hydrolysis and diallylation reactions of the niobium–alkyne complex provided further confirmation of its existence, with corresponding (Z)-alkene and diallylated products being isolated in good yields.
A new highly active low-valent alkoxyniobium species has been developed following the reaction of Nb(OEt)5 with Grignard reagent such as i-PrMgCl or EtMgCl, with the material behaving as an efficient catalyst for cyclotrimerization reaction of isocyanates. Display omitted
•A new highly active low-valent alkoxyniobium species has been developed.•An efficient catalyst for cyclotrimerization of isocyanates.•An efficient alternative to NbCl3(DME) in the field of organic synthesis.
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