Injuries to the extensor mechanism include a wide range of injuries from minor one to massive defect. And the methods of treatment must be individualized according to the anatomical site, extent and chronicity of injuries. The extensor mechanism is a triangular thin sheet like structure, the function of which cannot be explained completely by the Tubiana's church-steeple like diagram. Authors think that the extensor mechanism should be repaired or reconstructed as a triangular sheet. The tension of the repaired or reconstructed tendon was estimated as good when the neutral extensions were obtained in all the MP, PIP and DIP joints after the completion of sutures. Also authors think that stable sutures are mandatory for the early rehabilitation postopoeratively. Seventy-five patients have been treated by the authors from 1982 to 1994. According to zonal classification, forty-two patients were injured in Zone I. 5 in Zone II, 21 in Zone III, 5 in Zone IV and 2 patients were unclassified due to massive defects of the extensor mechanism. Mostly bony mallet injuries were treated by open reduction and K-wire fixation. Acute tendinous mallet injuries were treated by conservative splinting and old injuries were treated by anatomical plication of the terminal extensor tendon. Old buttonhole deformities were generally treated by the central tendon plication. Massive defects were managed by skin coverage and reconstruction of the extensor mechanism by using a tendon graft which was tailored like a triangular thin sheet. With author's treatment principles, excellent or good results were obtained in about 87%. Consequently, authors emphasize that an anatomical repair or reconstruction is a keystone in the treatment of injuries to the extensor mechanism.
Classification ; Congenital Abnormalities ; Fingers ; Fluconazole ; Humans ; Joints ; Rehabilitation ; Skin ; Splints ; Sutures ; Tendons ; Transplants

BACKGROUND: Intravascular ultrasound(IVUS) provides high resolution cross-sectional images of the vessels and permits the quantiative and qualitative assessment of coronary artery disease. Stent is a figid endovascular lattice that effectively prevents elastic recoil at treated sites, but in-stent restenois is a major limitation. The purpose of thecurrent study is to assess the contribution of neointimal hyperplasia for in-stent restenosis and the distribution and morphological characteristics of neointimal hyperplasia in deployed stents. METHODS: Thirty patients(male 25 & female 5;31 leions) deployed with intracoronary stents underwent intravascular ultrasound imaging at follow-up at least 4 months after stenting ([mean+/-SD] 8.3+/-2.9 months). RESULTS: 1) In-stent restenosis occurered in 15 lesions out of 31 lesions at follow-up coronary angiography. There was no difference in clinical characteristics between the restenotic and the non-restenotic groups. 2) There was no difference in angiographic profiles between two groups. Deployed stents were as follows ; 16 Palmaz-Schatz(P-S) stents, 12 Gianturco-Roubin(G-R) stents, 2 Cordis stents, and I Microstent II. Average diameter of stents in the restenotic and the non-restenotic groups were 3.07+/-0.26mm and 3.16+/-0.30mm, respectively(p=0.38). 3) There was no difference of stent cross-sectional areas(CSA) between the non-restenotic and the restenotic groups(p=0.476), but luminal CSA of the restenotic group was significantly smaller than that of the non-restenotic group(p=0.006). 4) In the restenotic group, there were no differences of the maximal and the minimal diameters of stents, and the mean CSAs of stents smong proxiaml, mid and distal segments. But the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the distal segment(p<0.05). There was a tendency thatthe mean CSA of neointimal hyperplasia at the mid segment was larger than that at the proximal segment(p=0.187). These findings were the same in the non-restenotic group. 5) In the restenotic group deployed with P-S stents, there were no differences of the maximal and the minimal diameters of stents, and the mean cross-sectional areas(CSA) of stents between each segment. But, the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the distal segment(p<0.005) and there was a tendency that the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the proximal segment(p=0.354). 6) In the morphology of neointimal hyperplasia of the restenotic group, eccentric form(77%) was more common than concentric form(22%). Neointimal hyperplasia occurred in focal or diffuse patterns(7 versus 8 cases). CONCLUSIONS: In-stent restenosis resulted from neointimal hyperplasia which almost mainly occurred eccentrically at the mid segment of stents and in focal or diffuse patterns. Intravascular ultrasound imaging was a useful method for recognition of distribution and morphological characteristics of neointimal hyperplasia at follow-up of deployed stents.
Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Female ; Follow-Up Studies ; Humans ; Hyperplasia* ; Phenobarbital ; Stents* ; Ultrasonography*

BACKGROUND AND OBJECTIVES: No existing device for cardiopulmonary resuscitation(CPR)isdesignedto exploit both the "cardiac pump" and the "thoracic pump" simultaneously. This study was designed to assess the hemodynamic effects of simultaneous sterno-thoracic CPR (SST-CPR) vs. standard CPR (S-CPR) using a mechanical resuscitator in a canine model of cardiac arrest. DEVICE DESCRIPTION: We have built a device that depresses the sternum and circumferentially constricts the thorax simultaneously. This device has two components. The first component is a piston, which depresses the sternum. The second is a circumferential strap that constricts the thorax as the piston is pushed down on the sternum. MATERIALS AND METHODS: Twelve domestic dogs were enrolled in this study. After catheterizations to measure pressures from the aorta and the right atrium, ventricular fibrillation was induced by passing AC current to the right ventricle. After 4 minutes of cardiac arrest, S-CPR and SST-CPR were performed alternatively. Aortic pressure, right atrial pressure, cardiac output, and end tidal CO2 were measured while each method of CPR was performing. RESULTS: SST-CPR resulted in significantly higher mean arterial pressure than S-CPR (68.9+/-16.1 vs 30.5+/-10.0 mmHg, p<0.01). SST-CPR could generate higher coronary perfusion pressure than S-CPR (47.0+/-11.4 vs 17.3+/-8.9 mmHg, p<0.01). End tidal CO2 tension was also higher during SST-CPR than S-CPR (11.6+/-6.1 vs 2.17+/-3.3 mmHg, p<0.01). CONCLUSION: Simultaneous sternothoracic cardiopulmonary resuscitation is a new method of cardiopulmonary resuscitation, which can generate better hemodynamic effects than standard cardiopulmonary resuscitation.
Animals ; Aorta ; Arterial Pressure ; Atrial Pressure ; Cardiac Output ; Cardiopulmonary Resuscitation* ; Catheterization ; Catheters ; Dogs ; Heart Arrest* ; Heart Atria ; Heart Ventricles ; Hemodynamics* ; Perfusion ; Sternum ; Thorax ; Ventricular Fibrillation

BACKGROUND AND OBJECTIVES: No existing device for cardiopulmonary resuscitation(CPR)isdesignedto exploit both the "cardiac pump" and the "thoracic pump" simultaneously. This study was designed to assess the hemodynamic effects of simultaneous sterno-thoracic CPR (SST-CPR) vs. standard CPR (S-CPR) using a mechanical resuscitator in a canine model of cardiac arrest. DEVICE DESCRIPTION: We have built a device that depresses the sternum and circumferentially constricts the thorax simultaneously. This device has two components. The first component is a piston, which depresses the sternum. The second is a circumferential strap that constricts the thorax as the piston is pushed down on the sternum. MATERIALS AND METHODS: Twelve domestic dogs were enrolled in this study. After catheterizations to measure pressures from the aorta and the right atrium, ventricular fibrillation was induced by passing AC current to the right ventricle. After 4 minutes of cardiac arrest, S-CPR and SST-CPR were performed alternatively. Aortic pressure, right atrial pressure, cardiac output, and end tidal CO2 were measured while each method of CPR was performing. RESULTS: SST-CPR resulted in significantly higher mean arterial pressure than S-CPR (68.9+/-16.1 vs 30.5+/-10.0 mmHg, p<0.01). SST-CPR could generate higher coronary perfusion pressure than S-CPR (47.0+/-11.4 vs 17.3+/-8.9 mmHg, p<0.01). End tidal CO2 tension was also higher during SST-CPR than S-CPR (11.6+/-6.1 vs 2.17+/-3.3 mmHg, p<0.01). CONCLUSION: Simultaneous sternothoracic cardiopulmonary resuscitation is a new method of cardiopulmonary resuscitation, which can generate better hemodynamic effects than standard cardiopulmonary resuscitation.
Animals ; Aorta ; Arterial Pressure ; Atrial Pressure ; Cardiac Output ; Cardiopulmonary Resuscitation* ; Catheterization ; Catheters ; Dogs ; Heart Arrest* ; Heart Atria ; Heart Ventricles ; Hemodynamics* ; Perfusion ; Sternum ; Thorax ; Ventricular Fibrillation

BACKGROUND: The aim of this study was to determine whether the conventional subcostal approach is suitable for emergency pericardiocentesis in patients with cardiac tamponade or impending cardiac tamponade. METHODS: This study was a prospective, observational study conducted at the emergency department of a tertiary hospital. Patients who had symptomatic pericardial effusion and who needed emergency pericardiocentesis in the emergency department were included in this study. We measured the epicardium-to-pericardium distance at the subcostal, parasternal, and apical area with two-dimensional echocardiography to determine the appropriate puncture site for pericardiocentesis. An epicardium-to-pericardium distance of more than 1.0cm was considered as the primary safety factor in determining the puncture site for pericardiocentesis. The skin-to-pericardium distance was considered as secondary safety factor. RESULTS: Ninety-five consecutive patients(55 males and 40 females; total mean age: 53 year old) with cardiac tamponade or impending cardiac tamponade were enrolled in this study. The puncture site for pericardiocentesis, as determined by echocardiography, was the subcostal area in 43 patients(45%), the apical area in 40 patients(42%), the left parasternal area in 11 patients(12%), and the right parasternal area in one patient(1%). Pericardiocentesis failed in 2 patients(2%) with the subcostal approach and in one patient(1%) with the apical approach. The average epicardium-to-pericardium distance was 31+/-21mm in patients with the subcostal approach and 21+/-8mm in patients with other approaches. There were no differences in the amount of pericardial fluid and in the intrapericardial pressure among patients groups according to puncture site. There were two procedure related complications: a puncture of the right ventricle with the subcostal approach and a ventricular tachycardia with the apical approach. CONCLUSION: The puncture site for emergency pericardiocentesis should be determined by using two-dimensional echocardiography because approaches from other areas can be safer than the subcostal approach.
Cardiac Tamponade ; Echocardiography ; Emergencies* ; Emergency Service, Hospital ; Female ; Heart Ventricles ; Humans ; Male ; Observational Study ; Pericardial Effusion ; Pericardiocentesis* ; Prospective Studies ; Punctures ; Tachycardia, Ventricular ; Tertiary Care Centers

BACKGROUND AND OBJECTIVES: We previously reported that, compared with standard cardiopulmonary resuscitation(S-CPR), better hemodynamic effects could be achieved by simultaneous sterno-thoracic cardiopulamonary resuscitation(SST-CPR) in which we compressed the sternum and constricted the thorax circumferentially during the systolic period by using a device. This study was designed to assess whether SST-CPR, compared with S-CPR, improve the survival rate of dogs with cardiac arrest. SUBJECTS AND METHODS: Twenty-five mongrel dogs(19~31kg) were enrolled in this study. After four minutes of ventricular fibrillation induced by an AC current, animals were randomized to resuscitate with either S-CPR(n=13) or SST-CPR(n=12). Epinephrine(1mg) was injected into the right atrium every three minutes after the beginning of CPR. Defibrillation was attempted after 6 minutes of CPR. Standard advanced cardiac life support was started if defibrillation was not successful. RESULTS: SST-CPR resulted in significantly(p<0.001) higher systolic arterial pressure(91+/- 47 vs 47+/-24mmHg), diastolic pressure(43+/- 24 vs 17+/- 10mmHg), coronary perfusion pressure(35+/- 25 vs 13+/- 9mmHg), and end tidal CO2 tension(9+/- 4 vs 3+/- 2mmHg). Two of 13 animals(15%) resuscitated with S-CPR and six of 12 animals(50%) resuscitated with SST-CPR survived until 12 hours after cardiac arrest(p<0.05). CONCLUSION: SST-CPR, compared with S-CPR, improves the short-term survival rate in canine cardiac arrests.
Advanced Cardiac Life Support ; Animals ; Cardiopulmonary Resuscitation* ; Dogs ; Heart Arrest* ; Heart Atria ; Hemodynamics ; Perfusion ; Sternum ; Survival Rate* ; Thorax ; Ventricular Fibrillation

OBJECTIVE: The aim of this study was to investigate the clinical significance of myocardial injuries in patients with nontraumatic intracranial hemorrhage by identifying the occurrence of myocardial injury and defining its correlation with subsequent cardiovascular events. SUBJECTS AND METHODS: One hundred twenty-four patients with nontraumatic intracraninal hemorrhage presented to the emergency department within six hours from onset of symptoms were enrolled. Brain CT, serial electrocardiography, and echocardiography were done at the emergency center. Blood samples for troponin I and creatine kinase(CK)-MB were drawn immediately and eight hours after admission. Troponin I and CK-MB were measured using a chemiluminescent immunoassay, respectively. RESULTS: Electrocardiographic and echocardiography abnormalities were found in 65 cases(52.4%) and 21 cases(17%), respectively. Serum troponin I and creatine kinase-MB were increased in 35 cases (28.2%) and in 58 cases(46.8%), respectively. Abnormal findings of echocardiography and ECG, as well as elevated levels of serum troponin I and creatine kinase-MB, were associated with an increased risk of cardiovascular event and survival. Logistic regression analysis revealed that an abnormal echcocardiographic finding and elevation of serum troponin I were factors associated with the occurrence an adverse cardiovascular event and that electrocardiographic abnormalities and initial mental status were factors associated with poor prognosis. CONCLUSION: This study reveals that actual myocardial injury develops in a significant proportion of patients with nontraumatic intracranial hemorrhage and that the development of the myocardial injury is associated with an adverse cardiovascular event that occurs during admission.
Brain ; Creatine ; Echocardiography ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Hemorrhage* ; Humans ; Immunoassay ; Intracranial Hemorrhages ; Logistic Models ; Prognosis ; Troponin I

BACKGROUND: Acute renal failure(ARF) is a serious complication of rhabdomyolysis after multiple trauma, and may increase morbidity and mortality. The aim of this study was to elucidate predicting factors for the development of ARF induced by rhabdomyolysis at an early stage of multiple trauma. METHODS: This prospective, observational study was conducted at the emergency department of a level I trauma center. Patients with acute multiple trauma, whose plasma levels of creatine phosphokinase(CPK) were higher than 1,000 IU, were included in this study. We excluded patients with any history of myocardial infarction, stroke, underlying renal disease, and/or infectious disease. We collected clinical and laboratory data including age, heart rate, mean arterial blood pressure, injury severity score, serum myoglobin, lactic dehydrogenase, creatine phosphokinase, and base excess. Collected data were compared between patients who had ARF and patients who did not have ARF. RESULTS: Eighty-eight patients were enrolled in this study. Eighteen patients(20.5%) developed ARF. The injury severity score(ISS)(p=0.001), the base excess(p<0.001), CPK(p=0.003), and myoglobin(p<0.001) were higher in patients with ARF than in patient without ARF. Logistic regression analysis revealed that early predictors for ARF were high ISS, high base excess, high CPK, and high myoglobin. CONCLUSION: We could identify early predicting factors for acute renal failure induced by rhabdomyolysis, these factors included ISS, serum CPK and myoglobin, and base excess in the arterial blood gas analysis performed at the emergency department.
Acute Kidney Injury* ; Arterial Pressure ; Blood Gas Analysis ; Communicable Diseases ; Creatine ; Creatine Kinase ; Emergency Service, Hospital ; Heart Rate ; Humans ; Injury Severity Score ; Logistic Models ; Mortality ; Multiple Trauma* ; Myocardial Infarction ; Myoglobin ; Observational Study ; Oxidoreductases ; Plasma ; Prospective Studies ; Rhabdomyolysis* ; Stroke ; Trauma Centers

PURPOSE: The aim of this study was to evaluate the reliability of the chief complaint addressing seizure in 119 run-sheets and to estimate the frequency of recommended administration of prehospital anti-convulsants. METHODS: A retrospective medical review of the period from 1 January, 2007 to 1 December, 2012 at one university hospital was conducted. Patients who were transported by 119 ambulance and whose chief complaint addressing seizure were enrolled. Medical records were independently reviewed by two emergency physicians. The reliability was analyzed according to the level of prehospital providers. prehospital providers. The operational definition of prehospital status epilepticus was cases with prolonged (lasting five minutes or more) or repetitive generalized convulsive seizures and seizure witnessed by 119 providers or persistent seizure at the time of arrival at the hospital. RESULTS: Among 239 medical records, 188(78.7%) cases with seizure were identified. The reliability was increased when level I emergency medical technicians were staffed(90.6% vs 74.3%). Psychiatric disorders(4.6%) and hyperventilation syndrome(3.8%) were frequently confused with seizure. Prehospital anti-convulsants were recommended in 15 cases(6.3%). CONCLUSION: Chief complaints addressing seizure by 119 prehospital providers were reliable. Not only rarity of prehospital status epilepticus but also other medical and legal barriers should be considered in regard to the possibility of prehospital anti-convulsant administration.
Ambulances ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; Humans ; Hyperventilation ; Medical Records ; Retrospective Studies ; Seizures ; Status Epilepticus

PURPOSE: The aim of this study was to evaluate the reliability of the chief complaint addressing seizure in 119 run-sheets and to estimate the frequency of recommended administration of prehospital anti-convulsants. METHODS: A retrospective medical review of the period from 1 January, 2007 to 1 December, 2012 at one university hospital was conducted. Patients who were transported by 119 ambulance and whose chief complaint addressing seizure were enrolled. Medical records were independently reviewed by two emergency physicians. The reliability was analyzed according to the level of prehospital providers. prehospital providers. The operational definition of prehospital status epilepticus was cases with prolonged (lasting five minutes or more) or repetitive generalized convulsive seizures and seizure witnessed by 119 providers or persistent seizure at the time of arrival at the hospital. RESULTS: Among 239 medical records, 188(78.7%) cases with seizure were identified. The reliability was increased when level I emergency medical technicians were staffed(90.6% vs 74.3%). Psychiatric disorders(4.6%) and hyperventilation syndrome(3.8%) were frequently confused with seizure. Prehospital anti-convulsants were recommended in 15 cases(6.3%). CONCLUSION: Chief complaints addressing seizure by 119 prehospital providers were reliable. Not only rarity of prehospital status epilepticus but also other medical and legal barriers should be considered in regard to the possibility of prehospital anti-convulsant administration.
Ambulances ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; Humans ; Hyperventilation ; Medical Records ; Retrospective Studies ; Seizures ; Status Epilepticus