BACKGROUND De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidate...BACKGROUND De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidates for surgical release.However,risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection.Currently,there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy.Thus,this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications.AIM To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions.METHODS Six cadaveric forearms,including four left and two right forearm specimens were dissected.Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon.Distance of the first dorsal compartment from landmarks such as Lister’s tubercle,the wrist crease,and the radial styloid were calculated.Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment,additional compartment subsheaths,number of abductor pollicis longus(APL)tendon slips,and the presence of a pseudo-retinaculum.RESULTS Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm±0.80 mm.The distance from Lister’s tubercle to the distal aspect of the extensor retinaculum was 13.37 mm±2.94 mm.Lister’s tubercle to the start of the first dorsal compartment was 18.43 mm±2.01 mm.The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm±0.99 mm.The retinaculum length longitudinally on average was 26.82 mm±3.34 mm.Four cadaveric forearms had separate extensor pollicis brevis compartments.The average number of APL tendon slips was three.A pseudo-retinaculum was present in four cadavers.Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally(7.03 mm and 13.36 mm).CONCLUSION An incision that measures 3 mm proximal from the radial styloid,2 cm radial from Lister’s tubercle,and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.展开更多
BACKGROUND Acute leg compartment syndrome is a well-known orthopedic emergency associated with potentially devastating consequences if not treated immediately.Multiple compartments are usually involved with a clear hi...BACKGROUND Acute leg compartment syndrome is a well-known orthopedic emergency associated with potentially devastating consequences if not treated immediately.Multiple compartments are usually involved with a clear history of trauma and classic symptoms and signs.However,isolated lateral leg compartment syndrome is relatively rare and is often misdiagnosed due to the atypical presentation of no trauma and the lack of pathognomonic signs.CASE SUMMARY A 31-year-old male patient presented to our emergency room with excruciating left calf pain and inability to mobilize one-day after participating in a football match despite no clear history of preceding trauma.The patient went to another hospital before presenting to us where he was diagnosed to have a soft tissue injury and was discharged home on simple analgesics.On clinical examination,the left leg showed a tense lateral compartment with severe tenderness.The pain was aggravated by dorsiflexion and ankle inversion.Neurovascular examination of the limb was normal.We suspected a compartment syndrome but as the presentation was atypical and an magnetic resonance imaging(MRI)was readily available in our institution,we immediately performed an MRI and this confirmed a large hematoma in the lateral compartment with a possible partial proximal peroneus longus muscle tear.The patient was taken immediately for an emergency open fasciotomy.The patient is now 18 mo postoperatively having recovered completely and engages fully in sports with no restrictions.CONCLUSION Atypical presentation due to the lack of pathognomonic signs makes the diagnosis of isolated lateral leg compartment syndrome difficult.Pain on passive inversion and dorsiflexion and weak active eversion may be suggested as sensitive signs.展开更多
BACKGROUND Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues.It typically appears with abrupt and intense pain,redness,and swel...BACKGROUND Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues.It typically appears with abrupt and intense pain,redness,and swelling in the affected joint.It frequently targets the lower extremities,such as the big toe.However,rarely,gout can manifest in atypical locations,including the hands,leading to an uncommon presentation known as gouty tenosynovitis.However,it can result in significant morbidity owing to the potential for severe complications,such as myonecrosis and compartment syndrome.CASE SUMMARY An 82-year-old male patient with a history of hypertension,cerebral infarction,Parkinson's disease,and recurrent gout attacks sought medical attention because of progressive pain and swelling in the right hand.Imaging findings revealed forearm swelling,raising concerns of possible tenosynovitis,bursitis,septic arthritis,and compartment syndrome.A fasciotomy was performed to decompress the patient’s hands and forearms.The procedure revealed diffuse tenosynovitis,tophi with a pus-like discharge surrounding the carpal tunnel,and involvement of the flexor and extensor tendon sheaths.However,microbiological investigations,including Gram staining,acid-fast bacilli,tuberculosis,and nontuberculous mycobacteria,yielded negative results.The patient was ultimately diagnosed with a severe gouty attack with compartment syndrome and myonecrosis.Septic arthritis and infectious flexor tenosynovitis were ruled out.Serial debridement and inflammation control were initiated,followed by staged closure with a skin graft.CONCLUSION Septic-like complications can occur in the absence of infection in severe gout attacks with pus-like discharges due to compartment syndrome and myonecrosis.Cultures can be used to differentiate between gouty attacks,septic arthritis,and infectious tenosynovitis.Involvement of the flexor and extensor muscles,as in this case,is rare.This study contributes to the literature by reporting a rare case of successful fasciotomy and serial debridement in an elderly patient with multiple comorbidities.展开更多
Green manure–crop rotation is a sustainable approach to protect crops against diseases and improve yield.However,the mechanism by which green manuring manipulates the crop-associated microbial community remains to be...Green manure–crop rotation is a sustainable approach to protect crops against diseases and improve yield.However,the mechanism by which green manuring manipulates the crop-associated microbial community remains to be elucidated.In this study,we explored the horizontal processes of bacterial communities in different compartments of the soil–root interface(bulk soil,rhizosphere soil,rhizoplane and endosphere)of tobacco by performing a field experiment including four rotation practices,namely,tobacco rotated with smooth vetch,ryegrass,radish,and winter fallow(without green manure).Results showed that the co-occurrence networks constructed by adjacent compartments of the soil–root interface with green manuring had more edges than without green manuring,indicating dramatic microbial interactions.Green manuring increased the dispersal-niche continuum index between bulk soil and other compartments,indicating that it facilitated the horizontal dispersal of microbes.For the different green manuring practices,the neutral community model explained 24.6–27.6%of detection frequency for bacteria,and at least one compartment under each practice had a normalized stochasticity ratio higher than the 50%boundary point,suggesting that the deterministic and stochastic processes jointly shaped the tobacco microbiome.In conclusion,green manuring generally facilitates bacterial community dispersal across different compartments and enhances potential interactions among adjacent compartments.This study provides empirical evidence for understanding the microbiome assembly under green manure–crop rotation.展开更多
BACKGROUND Although the finger compartment syndrome is not common,it compresses the neurovascular bundles in a limited space and blocks blood flow to the fingers,causing necrosis of the fingertips.Finger fasciotomy th...BACKGROUND Although the finger compartment syndrome is not common,it compresses the neurovascular bundles in a limited space and blocks blood flow to the fingers,causing necrosis of the fingertips.Finger fasciotomy through unilateral or bilateral midline release of the finger can achieve decompression of the finger compartment.Herein,we report a case of the compartment syndrome in a finger injury caused by a high-pressure water flow which is commonly used in car washing stations.CASE SUMMARY A 60-year-old man injured his right middle finger while using a high-pressure washer at a car washing station.The patient complained of severe pain in his middle finger and a 0.2 cm punctured open wound on the volar side of the distal phalangeal joint of the middle finger.The fingertip was pale,numb,and characterized by severe swelling and a limited range of motion.Finger radiography showed that there was no fracture in the finger.Digital decompression was performed through finger fasciotomy by bilateral midline incision.On the second day after surgery,the color of the fingertip returned to pink,swelling was resolved,and the range of motion returned to normal.The sensation of the fingertip was completely restored,and the capillary refill test and pinprick test were positive.CONCLUSION The fingertip compartment syndrome can be caused by a high-pressure water flow damage to the fingers when using high-pressure washers at a car washing station.To avoid finger necrosis,rapid diagnosis of the finger compartment syndrome and appropriate digital decompression are essential to better outcome.展开更多
The rate of disability due to acute osteofascial compartment syndrome(OCS)is high,and the therapeutic effect of decompressive fasciotomy is not ideal.This paper retrospectively reviews the modern treatment of OCS,incl...The rate of disability due to acute osteofascial compartment syndrome(OCS)is high,and the therapeutic effect of decompressive fasciotomy is not ideal.This paper retrospectively reviews the modern treatment of OCS,including Western medicine and Traditional Chinese medicine(TCM),mainly in the context of the advantages of TCM in the treatment process of decompressive fasciotomy or conservative treatment to the patients who are suffering from OCS.It was found that TCM treatment reduced the levels of serum creatine kinase(CK),lactate dehydrogenase(LDH),and aspartate aminotransferase(AST);it is beneficial to the elimination of swelling and pain.TCM adjunctive therapy promotes patients’postoperative functional recovery and decreases the occurrence of fasciotomy in patients;TCM can relieve tissue hypoxia of compartments and prevent necrosis of muscle and nerve tissue.TCM treatment improves the quality of medical service and ensures the safety of OCS patients.This paper aims to summarize the function of TCM in the treatment of OCS,provide reference for the clinical treatment of OCS,and improve the nursing/medical outcomes of OCS.展开更多
Intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)play a pivotal role in the pathophysiology of severe acute pancreatitis(SAP)and contribute to new-onset and persistent organ failure.The optimal ...Intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)play a pivotal role in the pathophysiology of severe acute pancreatitis(SAP)and contribute to new-onset and persistent organ failure.The optimal management of ACS involves a multi-disciplinary approach,from its early recognition to measures aiming at an urgent reduction of intra-abdominal pressure(IAP).A targeted literature search from January 1,2000,to November 30,2022,revealed 20 studies and data was analyzed on the type and country of the study,patient demographics,IAP,type and timing of surgical procedure performed,post-operative wound management,and outcomes of patients with ACS.There was no randomized controlled trial published on the topic.Decom-pressive laparotomy is effective in rapidly reducing IAP(standardized mean difference=2.68,95%confidence interval:1.19-1.47,P<0.001;4 studies).The morbidity and complications of an open abdomen after decompressive laparotomy should be weighed against the inadequately treated but,potentially lethal ACS.Disease-specific patient selection and the role of less-invasive decompressive measures,like subcutaneous linea alba fasciotomy or component separation techniques,is lacking in the 2013 consensus management guidelines by the Abdominal Compartment Society on IAH and ACS.This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP.However,there is a lack of high-quality evidence on patient selection,timing,and modality of surgical decompression.Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS.展开更多
AIM To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome(ACS) and to correlate it with functional outcome.METHODS Thirty-two tibial fractures with...AIM To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome(ACS) and to correlate it with functional outcome.METHODS Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale(LEFS)] and complications were assessed.RESULTS Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk(10 to 54 wk) and 23.8 ± 9.2 wk(12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness(76%) that caused difficulty in walking,running and squatting. Of 21 patients who had paralysis at diagnosis, 13(62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients(48.3%) with severe disability, 10 patients(34.5%) with moderate disability and 5 patients(17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmH g respectively(P < 0.001).CONCLUSION ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intracompartmental pressure(ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.展开更多
BACKGROUND Endoscopic fasciotomy of the forearm for chronic exertional compartment syndrome(CECS)has gained popularity recently.AIM To systematically review the literature of endoscopic fasciotomy for CECS of the fore...BACKGROUND Endoscopic fasciotomy of the forearm for chronic exertional compartment syndrome(CECS)has gained popularity recently.AIM To systematically review the literature of endoscopic fasciotomy for CECS of the forearm,aiming to assess the outcomes and complications of the different endoscopic fasciotomy techniques described in the literature.METHODS On January 18,2021,PubMed and EMBASE were searched by 3 reviewers independently,and all relevant studies published up to that date were considered based on predetermined inclusion/exclusion criteria.The subject headings“endoscopic fasciotomy”and“compartment syndrome”and their related key terms were used.The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.RESULTS A total of seven studies including 183 patients(355 forearms)were included.The mean age of the patients was 31.2 years(range:15-42 years).The postoperative follow-up duration ranged from 6 wk to 4.9 years.All patients were able to return to sport activities between postoperative weeks 1 to 8.Recurrence of the compartment syndrome occurred in three patients,giving a rate of 1.6%per patient and 0.8%per forearm.The overall complication rate was 8.7%per patient,and 4.5%per forearm.The most common reported complication was hematoma(7 forearms;2.0%).CONCLUSION Endoscopic fasciotomy for CECS of the forearm has favorable short-and midterm outcomes with very low recurrence and complication rates.This,however,needs to be confirmed in larger,long-term follow-up,prospective,comparative studies between open,mini-open and endoscopic fasciotomy techniques.展开更多
Acute compartment syndrome usually occurs after a traumatic event, typically in association with a fracture, but also from a soft tissue injury such as a direct blow or crush. Acute, isolated, medial compartment syndr...Acute compartment syndrome usually occurs after a traumatic event, typically in association with a fracture, but also from a soft tissue injury such as a direct blow or crush. Acute, isolated, medial compartment syndrome of the foot without a specific major trauma is very rare. I am reporting a rare case with acute compartment syndrome for isolated medial compartment of foot after a traumatic sport event and proper management to prevent long term sequels.展开更多
Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH...Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.展开更多
Acute compartment syndrome(ACS) of the thigh following primary total hip arthroplasty(THA) is a highly uncommon complication and has not yet been reported before with regards to the anterior approach through the anter...Acute compartment syndrome(ACS) of the thigh following primary total hip arthroplasty(THA) is a highly uncommon complication and has not yet been reported before with regards to the anterior approach through the anterior supine interval. We present a case of a 69-year-old male patient with a history of stroke, who developed ACS of the thigh after elective THA while using therapeutic low molecular weight heparin as bridging for regular oral anticoagulation. ACS pathogenesis, diagnostic tools, treatment and relevant literature are discussed. The patient's ACS was recognized in time and treated by operative decompression with fasciotomy of the anterior compartment. Follow-up did not show any neurological deficit or soft-tissue damage.展开更多
Myocardial pathologies are major causes of morbidity and mortality worldwide. Early detection of loss of cellular integrity and expansion in extracellular volume(ECV) in myocardium is critical to initiate effective tr...Myocardial pathologies are major causes of morbidity and mortality worldwide. Early detection of loss of cellular integrity and expansion in extracellular volume(ECV) in myocardium is critical to initiate effective treatment. The three compartments in healthy myocardium are: intravascular(approximately 10% of tissue volume), interstitium(approximately 15%) and intracellular(approximately 75%). Myocardial cells, fibroblasts and vascular endothelial/smooth muscle cells represent intracellular compartment and the main proteins in the interstitium are types Ⅰ/Ⅲ collagens. Microscopic studies have shown that expansion of ECV is an important feature of diffuse physiologic fibrosis(e.g., aging and obesity) and pathologic fibrosis [heart failure, aortic valve disease, hypertrophic cardiomyopathy, myocarditis, dilated cardiomyopathy, amyloidosis, congenital heart disease, aortic stenosis, restrictive cardiomyopathy(hypereosinophilic and idiopathic types), arrythmogenic right ventricular dysplasia and hypertension]. This review addresses recent advances in measuring of ECV in ischemic and non-ischemic myocardial pathologies. Magnetic resonance imaging(MRI) has the ability to characterize tissue proton relaxation times(T1, T2, and T2*). Proton relaxation times reflect the physical and chemical environments of water protons in myocardium. Delayed contrast enhanced-MRI(DE-MRI) and multi-detector computed tomography(DE-MDCT) demonstrated hyper-enhanced infarct, hypo-enhanced microvascular obstruction zone and moderately enhanced peri-infarct zone, but are limited for visualizing diffuse fibrosis and patchy microinfarct despite the increase in ECV. ECV can be measured on equilibrium contrast enhanced MRI/MDCT and MRI longitudinal relaxation time mapping. Equilibrium contrast enhanced MRI/MDCT and MRI T1 mapping is currently used, but at a lower scale, as an alternative to invasive sub-endomyocardial biopsies to eliminate the need for anesthesia, coronary catheterization and possibility of tissue sampling error. Similar to delayed contrast enhancement, equilibrium contrast enhanced MRI/MDCT and T1 mapping is completely noninvasive and may play a specialized role in diagnosis of subclinical and other myocardial pathologies. DE-MRI and when T1-mapping demonstrated sub-epicardium, sub-endocardial and patchy mid-myocardial enhancement in myocarditis, Behcet's disease and sarcoidosis, respectively. Furthermore, recent studies showed that the combined technique of cine, T2-weighted and DE-MRI technique has high diagnostic accuracy for detecting myocarditis. When the tomographic techniques are coupled with myocardial perfusion and left ventricular function they can provide valuable information on the progression of myocardial pathologies and effectiveness of new therapies.展开更多
Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compl...Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compliance,and other factors that exert a constant pressure within the abdominal cavity.Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction.Among surgical and trauma patients,aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS.Other conditions that have also been identified as risk factors are ascites,hemoperitoneum,bowel distention,and large tumors.All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH).Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery,abdominal aortic aneurysm repair,and liver transplantation among others.Close monitoring of organ function and intra-abdominal pressure(IAP)allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP.Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction.There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.展开更多
BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery(ENOTES) in treating severe acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS).ME...BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery(ENOTES) in treating severe acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS).METHODS: The patients, who were randomized into an ENOTES group and an operative group, underwent ENOTES and laparotomy, respectively. The results and complications of the two groups were compared.RESULTS: Enterocinesia was observed earlier in the ENOTES group than in the operative group. Acute Physiology and Chronic Health Evaluation II(APACHE II) score of patients in the ENOTES group was lower than that of the operative group on the 1st, 3rd and 5th post-operative day(P<0.05). The cure rate was 96.87% in the ENOTES group, which was statistically different from 78.12% in the operative group(P<0.05). There were significant differences in complications and mortality between the two groups(P<0.01).CONCLUSION: Compared with surgical decompression, ENOTES associated with flexible endoscope therapy is an effective and minimal invasive procedure with less complications.展开更多
BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pa...BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.展开更多
BACKGROUND Fascia iliaca compartment block is a technique that blocks three nerves,similar to a 3-in-1 nerve block.This block provides analgesia for patients undergoing lower limb surgery,and is a simple technique tha...BACKGROUND Fascia iliaca compartment block is a technique that blocks three nerves,similar to a 3-in-1 nerve block.This block provides analgesia for patients undergoing lower limb surgery,and is a simple technique that is easy to implement.Here,we report a case of fascia iliaca compartment block in a patient with myocardial infarction who underwent emergency middle thigh amputation.CASE SUMMARY A 78-year-old female patient weighing 38 kg with gangrene and occlusive peripheral atherosclerosis of the right leg underwent an emergency middle thigh amputation.The patient had a history of hypertension,coronary heart disease,cerebral infarction,anterior wall myocardial infarction,and had recently undergone percutaneous coronary intervention consisting of coronary angiography and right coronary artery stent implantation.Considering the patient's condition,an ultrasound-guided fascia iliaca compartment block combined with general anesthesia was implemented for amputation.The fascia iliaca compartment block provided analgesia for the operation,and reduced the dosage of general anesthetics.It also alleviated adverse cardiovascular effects caused by pain stress,and ensured the safety of the patient during the perioperative period.This block also provided postoperative analgesia.The patient had a good prognosis,and was subsequently discharged from hospital.CONCLUSION Fascia iliaca compartment block provides surgical analgesia.It also alleviates adverse cardiovascular effects,and ensures patient safety during the perioperative period.展开更多
Objective: The objective of this study was to reduce or avoid the occurrence of the cases of osteofascial compartment syndrome induced by a radial artery puncture for arterial blood gas analysis.Methods: We analyzed a...Objective: The objective of this study was to reduce or avoid the occurrence of the cases of osteofascial compartment syndrome induced by a radial artery puncture for arterial blood gas analysis.Methods: We analyzed an adverse event using cheese model analysis, "fish bone M analysis, root cause analysis, and other methods.Results: There are three root causes leading to an adverse event: operation technique, assessment of the disease, and informing patient families. However, there are many reasons to promote the occurrence and development of the event.O>ndusions: We should analyze and manage the adverse events in patients from the point of view of a system. Developing the measures of a system defense can enhance patient safety and create a good safety culture.展开更多
Liquid-filled compartment structure consists of a bulk steel plate with matrix blind holes which are filled with liquid and a steel front plate to seal up the liquid with rings and bolts.The liquid-filled compartment ...Liquid-filled compartment structure consists of a bulk steel plate with matrix blind holes which are filled with liquid and a steel front plate to seal up the liquid with rings and bolts.The liquid-filled compartment structure can resist the shaped charge warhead effectively.This paper presents experimental and theoretical investigations of the penetration ability of the residual shaped charge jet emerging from the liquid-filled compartment structure after the penetration process at different impact angles.On the basis of shock wave propagation theory,the influence of the liquid-filled compartment structure on jet stability is analysed.The interferences of the liquid backflow caused by a reflected shock wave and a back plate on jet stability under different impact angles are also examined.In addition,the range of the disturbed velocity segments of the jet at different impact angles and the penetration ability of the residual jet are obtained.A theoretical model is validated against the experimental penetration depths.展开更多
文摘BACKGROUND De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidates for surgical release.However,risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection.Currently,there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy.Thus,this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications.AIM To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions.METHODS Six cadaveric forearms,including four left and two right forearm specimens were dissected.Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon.Distance of the first dorsal compartment from landmarks such as Lister’s tubercle,the wrist crease,and the radial styloid were calculated.Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment,additional compartment subsheaths,number of abductor pollicis longus(APL)tendon slips,and the presence of a pseudo-retinaculum.RESULTS Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm±0.80 mm.The distance from Lister’s tubercle to the distal aspect of the extensor retinaculum was 13.37 mm±2.94 mm.Lister’s tubercle to the start of the first dorsal compartment was 18.43 mm±2.01 mm.The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm±0.99 mm.The retinaculum length longitudinally on average was 26.82 mm±3.34 mm.Four cadaveric forearms had separate extensor pollicis brevis compartments.The average number of APL tendon slips was three.A pseudo-retinaculum was present in four cadavers.Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally(7.03 mm and 13.36 mm).CONCLUSION An incision that measures 3 mm proximal from the radial styloid,2 cm radial from Lister’s tubercle,and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.
文摘BACKGROUND Acute leg compartment syndrome is a well-known orthopedic emergency associated with potentially devastating consequences if not treated immediately.Multiple compartments are usually involved with a clear history of trauma and classic symptoms and signs.However,isolated lateral leg compartment syndrome is relatively rare and is often misdiagnosed due to the atypical presentation of no trauma and the lack of pathognomonic signs.CASE SUMMARY A 31-year-old male patient presented to our emergency room with excruciating left calf pain and inability to mobilize one-day after participating in a football match despite no clear history of preceding trauma.The patient went to another hospital before presenting to us where he was diagnosed to have a soft tissue injury and was discharged home on simple analgesics.On clinical examination,the left leg showed a tense lateral compartment with severe tenderness.The pain was aggravated by dorsiflexion and ankle inversion.Neurovascular examination of the limb was normal.We suspected a compartment syndrome but as the presentation was atypical and an magnetic resonance imaging(MRI)was readily available in our institution,we immediately performed an MRI and this confirmed a large hematoma in the lateral compartment with a possible partial proximal peroneus longus muscle tear.The patient was taken immediately for an emergency open fasciotomy.The patient is now 18 mo postoperatively having recovered completely and engages fully in sports with no restrictions.CONCLUSION Atypical presentation due to the lack of pathognomonic signs makes the diagnosis of isolated lateral leg compartment syndrome difficult.Pain on passive inversion and dorsiflexion and weak active eversion may be suggested as sensitive signs.
文摘BACKGROUND Gout is a common type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues.It typically appears with abrupt and intense pain,redness,and swelling in the affected joint.It frequently targets the lower extremities,such as the big toe.However,rarely,gout can manifest in atypical locations,including the hands,leading to an uncommon presentation known as gouty tenosynovitis.However,it can result in significant morbidity owing to the potential for severe complications,such as myonecrosis and compartment syndrome.CASE SUMMARY An 82-year-old male patient with a history of hypertension,cerebral infarction,Parkinson's disease,and recurrent gout attacks sought medical attention because of progressive pain and swelling in the right hand.Imaging findings revealed forearm swelling,raising concerns of possible tenosynovitis,bursitis,septic arthritis,and compartment syndrome.A fasciotomy was performed to decompress the patient’s hands and forearms.The procedure revealed diffuse tenosynovitis,tophi with a pus-like discharge surrounding the carpal tunnel,and involvement of the flexor and extensor tendon sheaths.However,microbiological investigations,including Gram staining,acid-fast bacilli,tuberculosis,and nontuberculous mycobacteria,yielded negative results.The patient was ultimately diagnosed with a severe gouty attack with compartment syndrome and myonecrosis.Septic arthritis and infectious flexor tenosynovitis were ruled out.Serial debridement and inflammation control were initiated,followed by staged closure with a skin graft.CONCLUSION Septic-like complications can occur in the absence of infection in severe gout attacks with pus-like discharges due to compartment syndrome and myonecrosis.Cultures can be used to differentiate between gouty attacks,septic arthritis,and infectious tenosynovitis.Involvement of the flexor and extensor muscles,as in this case,is rare.This study contributes to the literature by reporting a rare case of successful fasciotomy and serial debridement in an elderly patient with multiple comorbidities.
基金supported financially by the National Key Research and Development Program of China(2021YFD1700200)the China Agriculture Research System of MOF and MARA(CARS-22).
文摘Green manure–crop rotation is a sustainable approach to protect crops against diseases and improve yield.However,the mechanism by which green manuring manipulates the crop-associated microbial community remains to be elucidated.In this study,we explored the horizontal processes of bacterial communities in different compartments of the soil–root interface(bulk soil,rhizosphere soil,rhizoplane and endosphere)of tobacco by performing a field experiment including four rotation practices,namely,tobacco rotated with smooth vetch,ryegrass,radish,and winter fallow(without green manure).Results showed that the co-occurrence networks constructed by adjacent compartments of the soil–root interface with green manuring had more edges than without green manuring,indicating dramatic microbial interactions.Green manuring increased the dispersal-niche continuum index between bulk soil and other compartments,indicating that it facilitated the horizontal dispersal of microbes.For the different green manuring practices,the neutral community model explained 24.6–27.6%of detection frequency for bacteria,and at least one compartment under each practice had a normalized stochasticity ratio higher than the 50%boundary point,suggesting that the deterministic and stochastic processes jointly shaped the tobacco microbiome.In conclusion,green manuring generally facilitates bacterial community dispersal across different compartments and enhances potential interactions among adjacent compartments.This study provides empirical evidence for understanding the microbiome assembly under green manure–crop rotation.
文摘BACKGROUND Although the finger compartment syndrome is not common,it compresses the neurovascular bundles in a limited space and blocks blood flow to the fingers,causing necrosis of the fingertips.Finger fasciotomy through unilateral or bilateral midline release of the finger can achieve decompression of the finger compartment.Herein,we report a case of the compartment syndrome in a finger injury caused by a high-pressure water flow which is commonly used in car washing stations.CASE SUMMARY A 60-year-old man injured his right middle finger while using a high-pressure washer at a car washing station.The patient complained of severe pain in his middle finger and a 0.2 cm punctured open wound on the volar side of the distal phalangeal joint of the middle finger.The fingertip was pale,numb,and characterized by severe swelling and a limited range of motion.Finger radiography showed that there was no fracture in the finger.Digital decompression was performed through finger fasciotomy by bilateral midline incision.On the second day after surgery,the color of the fingertip returned to pink,swelling was resolved,and the range of motion returned to normal.The sensation of the fingertip was completely restored,and the capillary refill test and pinprick test were positive.CONCLUSION The fingertip compartment syndrome can be caused by a high-pressure water flow damage to the fingers when using high-pressure washers at a car washing station.To avoid finger necrosis,rapid diagnosis of the finger compartment syndrome and appropriate digital decompression are essential to better outcome.
基金supported by Henan University Undergraduate Teaching Reform Research and Practice Project:Innovative Geriatric Nursing Professional Training Mode Reform and Practice(No.HDXJJG2020-09)Henan Province Higher Education Teaching Reform Research and Practice Project(No.2021SJGLX333)Henan Medical Education Research Project(No.wjlx2021046).
文摘The rate of disability due to acute osteofascial compartment syndrome(OCS)is high,and the therapeutic effect of decompressive fasciotomy is not ideal.This paper retrospectively reviews the modern treatment of OCS,including Western medicine and Traditional Chinese medicine(TCM),mainly in the context of the advantages of TCM in the treatment process of decompressive fasciotomy or conservative treatment to the patients who are suffering from OCS.It was found that TCM treatment reduced the levels of serum creatine kinase(CK),lactate dehydrogenase(LDH),and aspartate aminotransferase(AST);it is beneficial to the elimination of swelling and pain.TCM adjunctive therapy promotes patients’postoperative functional recovery and decreases the occurrence of fasciotomy in patients;TCM can relieve tissue hypoxia of compartments and prevent necrosis of muscle and nerve tissue.TCM treatment improves the quality of medical service and ensures the safety of OCS patients.This paper aims to summarize the function of TCM in the treatment of OCS,provide reference for the clinical treatment of OCS,and improve the nursing/medical outcomes of OCS.
文摘Intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)play a pivotal role in the pathophysiology of severe acute pancreatitis(SAP)and contribute to new-onset and persistent organ failure.The optimal management of ACS involves a multi-disciplinary approach,from its early recognition to measures aiming at an urgent reduction of intra-abdominal pressure(IAP).A targeted literature search from January 1,2000,to November 30,2022,revealed 20 studies and data was analyzed on the type and country of the study,patient demographics,IAP,type and timing of surgical procedure performed,post-operative wound management,and outcomes of patients with ACS.There was no randomized controlled trial published on the topic.Decom-pressive laparotomy is effective in rapidly reducing IAP(standardized mean difference=2.68,95%confidence interval:1.19-1.47,P<0.001;4 studies).The morbidity and complications of an open abdomen after decompressive laparotomy should be weighed against the inadequately treated but,potentially lethal ACS.Disease-specific patient selection and the role of less-invasive decompressive measures,like subcutaneous linea alba fasciotomy or component separation techniques,is lacking in the 2013 consensus management guidelines by the Abdominal Compartment Society on IAH and ACS.This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP.However,there is a lack of high-quality evidence on patient selection,timing,and modality of surgical decompression.Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS.
文摘AIM To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome(ACS) and to correlate it with functional outcome.METHODS Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale(LEFS)] and complications were assessed.RESULTS Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk(10 to 54 wk) and 23.8 ± 9.2 wk(12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness(76%) that caused difficulty in walking,running and squatting. Of 21 patients who had paralysis at diagnosis, 13(62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients(48.3%) with severe disability, 10 patients(34.5%) with moderate disability and 5 patients(17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmH g respectively(P < 0.001).CONCLUSION ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intracompartmental pressure(ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.
文摘BACKGROUND Endoscopic fasciotomy of the forearm for chronic exertional compartment syndrome(CECS)has gained popularity recently.AIM To systematically review the literature of endoscopic fasciotomy for CECS of the forearm,aiming to assess the outcomes and complications of the different endoscopic fasciotomy techniques described in the literature.METHODS On January 18,2021,PubMed and EMBASE were searched by 3 reviewers independently,and all relevant studies published up to that date were considered based on predetermined inclusion/exclusion criteria.The subject headings“endoscopic fasciotomy”and“compartment syndrome”and their related key terms were used.The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.RESULTS A total of seven studies including 183 patients(355 forearms)were included.The mean age of the patients was 31.2 years(range:15-42 years).The postoperative follow-up duration ranged from 6 wk to 4.9 years.All patients were able to return to sport activities between postoperative weeks 1 to 8.Recurrence of the compartment syndrome occurred in three patients,giving a rate of 1.6%per patient and 0.8%per forearm.The overall complication rate was 8.7%per patient,and 4.5%per forearm.The most common reported complication was hematoma(7 forearms;2.0%).CONCLUSION Endoscopic fasciotomy for CECS of the forearm has favorable short-and midterm outcomes with very low recurrence and complication rates.This,however,needs to be confirmed in larger,long-term follow-up,prospective,comparative studies between open,mini-open and endoscopic fasciotomy techniques.
文摘Acute compartment syndrome usually occurs after a traumatic event, typically in association with a fracture, but also from a soft tissue injury such as a direct blow or crush. Acute, isolated, medial compartment syndrome of the foot without a specific major trauma is very rare. I am reporting a rare case with acute compartment syndrome for isolated medial compartment of foot after a traumatic sport event and proper management to prevent long term sequels.
文摘Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.
文摘Acute compartment syndrome(ACS) of the thigh following primary total hip arthroplasty(THA) is a highly uncommon complication and has not yet been reported before with regards to the anterior approach through the anterior supine interval. We present a case of a 69-year-old male patient with a history of stroke, who developed ACS of the thigh after elective THA while using therapeutic low molecular weight heparin as bridging for regular oral anticoagulation. ACS pathogenesis, diagnostic tools, treatment and relevant literature are discussed. The patient's ACS was recognized in time and treated by operative decompression with fasciotomy of the anterior compartment. Follow-up did not show any neurological deficit or soft-tissue damage.
文摘Myocardial pathologies are major causes of morbidity and mortality worldwide. Early detection of loss of cellular integrity and expansion in extracellular volume(ECV) in myocardium is critical to initiate effective treatment. The three compartments in healthy myocardium are: intravascular(approximately 10% of tissue volume), interstitium(approximately 15%) and intracellular(approximately 75%). Myocardial cells, fibroblasts and vascular endothelial/smooth muscle cells represent intracellular compartment and the main proteins in the interstitium are types Ⅰ/Ⅲ collagens. Microscopic studies have shown that expansion of ECV is an important feature of diffuse physiologic fibrosis(e.g., aging and obesity) and pathologic fibrosis [heart failure, aortic valve disease, hypertrophic cardiomyopathy, myocarditis, dilated cardiomyopathy, amyloidosis, congenital heart disease, aortic stenosis, restrictive cardiomyopathy(hypereosinophilic and idiopathic types), arrythmogenic right ventricular dysplasia and hypertension]. This review addresses recent advances in measuring of ECV in ischemic and non-ischemic myocardial pathologies. Magnetic resonance imaging(MRI) has the ability to characterize tissue proton relaxation times(T1, T2, and T2*). Proton relaxation times reflect the physical and chemical environments of water protons in myocardium. Delayed contrast enhanced-MRI(DE-MRI) and multi-detector computed tomography(DE-MDCT) demonstrated hyper-enhanced infarct, hypo-enhanced microvascular obstruction zone and moderately enhanced peri-infarct zone, but are limited for visualizing diffuse fibrosis and patchy microinfarct despite the increase in ECV. ECV can be measured on equilibrium contrast enhanced MRI/MDCT and MRI longitudinal relaxation time mapping. Equilibrium contrast enhanced MRI/MDCT and MRI T1 mapping is currently used, but at a lower scale, as an alternative to invasive sub-endomyocardial biopsies to eliminate the need for anesthesia, coronary catheterization and possibility of tissue sampling error. Similar to delayed contrast enhancement, equilibrium contrast enhanced MRI/MDCT and T1 mapping is completely noninvasive and may play a specialized role in diagnosis of subclinical and other myocardial pathologies. DE-MRI and when T1-mapping demonstrated sub-epicardium, sub-endocardial and patchy mid-myocardial enhancement in myocarditis, Behcet's disease and sarcoidosis, respectively. Furthermore, recent studies showed that the combined technique of cine, T2-weighted and DE-MRI technique has high diagnostic accuracy for detecting myocarditis. When the tomographic techniques are coupled with myocardial perfusion and left ventricular function they can provide valuable information on the progression of myocardial pathologies and effectiveness of new therapies.
文摘Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compliance,and other factors that exert a constant pressure within the abdominal cavity.Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction.Among surgical and trauma patients,aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS.Other conditions that have also been identified as risk factors are ascites,hemoperitoneum,bowel distention,and large tumors.All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH).Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery,abdominal aortic aneurysm repair,and liver transplantation among others.Close monitoring of organ function and intra-abdominal pressure(IAP)allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP.Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction.There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.
文摘BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery(ENOTES) in treating severe acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS).METHODS: The patients, who were randomized into an ENOTES group and an operative group, underwent ENOTES and laparotomy, respectively. The results and complications of the two groups were compared.RESULTS: Enterocinesia was observed earlier in the ENOTES group than in the operative group. Acute Physiology and Chronic Health Evaluation II(APACHE II) score of patients in the ENOTES group was lower than that of the operative group on the 1st, 3rd and 5th post-operative day(P<0.05). The cure rate was 96.87% in the ENOTES group, which was statistically different from 78.12% in the operative group(P<0.05). There were significant differences in complications and mortality between the two groups(P<0.01).CONCLUSION: Compared with surgical decompression, ENOTES associated with flexible endoscope therapy is an effective and minimal invasive procedure with less complications.
文摘BACKGROUND: Fascia iliaca compartment nerve block(FICNB) has been an established technique for postoperative analgesia after surgery for femoral bone fracture. FICNB is technically easy, effective for postoperative pain control after operation for femoral bone fracture and decreases the complications induced by systemic analgesic drugs. The severity of postoperative pain is affected by genetics, cultural and social factors across the world. In this study we assessed the efficacy of fascia iliaca compartment nerve block when it is used as part of multimodal analgesia after surgery for femoral bone fracture.METHODS: An institution-based case control study was conducted from September, 2013 to May, 2014. All patients who had been operated on under spinal anesthesia for femoral bone fracture were included. The patients divided into a FICNB group(n=20) and a control group(n=20). The FICNB group was given 30 mL of 0.25% bupivacaine at the end of the operation. Postoperative pain was assessed within the f irst 24 hours, i.e. at 15 minutes, 2 hours, 6 hours, 12 hours and 24 hours using 100 mm visual analogue scale(VAS), total analgesic consumption, and the time for the f irst analgesic request.RESULTS: VAS pain scores were reduced within the f irst 24 hours after operation in the FICNB group compared wtih the control group. VAS scores at 2 hours were taken as median values(IQR) 0.00(0.00) vs.18.00(30.00), P=0.001; at 6 hours 0.00(0.00) vs. 34.00(20.75), P=0.000; at 24 hours 12.50(10.00) vs. 31.50(20.75), P=0.004; and at 12 hours(17.80±12.45) vs.(29.95±12.40), P=0.004, respectively. The total analgesic consumption of diclofenac at 12 and 24 hours was reduced in the FICNB group, and the time for the fi rst analgesic request was signifi cantly prolonged(417.50 vs. 139.25 minutes, P=0.000).CONCLUSIONS: A single injection for FICNB could lead to postoperative pain relief, reduction of total analgesic consumption and prolonged time for the fi rst analgesic request in the FICNB group after surgery for femoral bone fracture. We recommend FICNB for analgesia after surgery for femoral bone fracture and for patients with femoral bone fracture at the emergency department.
文摘BACKGROUND Fascia iliaca compartment block is a technique that blocks three nerves,similar to a 3-in-1 nerve block.This block provides analgesia for patients undergoing lower limb surgery,and is a simple technique that is easy to implement.Here,we report a case of fascia iliaca compartment block in a patient with myocardial infarction who underwent emergency middle thigh amputation.CASE SUMMARY A 78-year-old female patient weighing 38 kg with gangrene and occlusive peripheral atherosclerosis of the right leg underwent an emergency middle thigh amputation.The patient had a history of hypertension,coronary heart disease,cerebral infarction,anterior wall myocardial infarction,and had recently undergone percutaneous coronary intervention consisting of coronary angiography and right coronary artery stent implantation.Considering the patient's condition,an ultrasound-guided fascia iliaca compartment block combined with general anesthesia was implemented for amputation.The fascia iliaca compartment block provided analgesia for the operation,and reduced the dosage of general anesthetics.It also alleviated adverse cardiovascular effects caused by pain stress,and ensured the safety of the patient during the perioperative period.This block also provided postoperative analgesia.The patient had a good prognosis,and was subsequently discharged from hospital.CONCLUSION Fascia iliaca compartment block provides surgical analgesia.It also alleviates adverse cardiovascular effects,and ensures patient safety during the perioperative period.
文摘Objective: The objective of this study was to reduce or avoid the occurrence of the cases of osteofascial compartment syndrome induced by a radial artery puncture for arterial blood gas analysis.Methods: We analyzed an adverse event using cheese model analysis, "fish bone M analysis, root cause analysis, and other methods.Results: There are three root causes leading to an adverse event: operation technique, assessment of the disease, and informing patient families. However, there are many reasons to promote the occurrence and development of the event.O>ndusions: We should analyze and manage the adverse events in patients from the point of view of a system. Developing the measures of a system defense can enhance patient safety and create a good safety culture.
基金This research was supported by the National Natural Science Foundation of China(Grant No.11472115,11872214)the China Scholarship Council(201706845026).
文摘Liquid-filled compartment structure consists of a bulk steel plate with matrix blind holes which are filled with liquid and a steel front plate to seal up the liquid with rings and bolts.The liquid-filled compartment structure can resist the shaped charge warhead effectively.This paper presents experimental and theoretical investigations of the penetration ability of the residual shaped charge jet emerging from the liquid-filled compartment structure after the penetration process at different impact angles.On the basis of shock wave propagation theory,the influence of the liquid-filled compartment structure on jet stability is analysed.The interferences of the liquid backflow caused by a reflected shock wave and a back plate on jet stability under different impact angles are also examined.In addition,the range of the disturbed velocity segments of the jet at different impact angles and the penetration ability of the residual jet are obtained.A theoretical model is validated against the experimental penetration depths.
