No abstract available.
Learning* ; Social Media* ; Unconscious (Psychology)*

Acute compartment syndrome of the lower leg and foot is a surgical emergency. The clinical symptoms is an important clue to diagnose compartment syndrome. In cases of ambiguous diagnosis, unconscious patients and children additionally need a intracompartmental pressure measuring. Immediate fasciotomy should be performed when clinical signs are obvious or when delta pressure is less than 30 mmHg or intracompartmental pressure is greater than 30 mmHg. Fasciotomy of the lower leg can be performed either by one lateral single incision or double incision, which of the foot mainly has a dorsal or medial incision. A delayed in diagnosis that leads to a delay in treatment can result in devastating disability. Acute compartment syndrome of the lower leg and foot is a relative rare but serious complication of which a surgeon should be aware.
Child ; Compartment Syndromes ; Emergencies ; Foot ; Humans ; Leg ; Unconscious (Psychology)

PURPOSE: The evaluation and management of a completely transected tendon of the hand is relatively clear. In most cases, the integrity is assessed by physical examination(eg, broken normal cascade, motion loss) but occasionally, It happens in troubles. because of pain, limited patient cooperation(eg, child, unconscious patient), and other associated injuries(eg, fractures, foreign bodies). METHODS: From september 2006 to August 2007, 28 patients were evaluated with real time ultrasonography preoperatively and postoperatively. Twenty eight patients with injured tendon were evaluated using an HDI 5000 Sono CT(Philips Medical Systems, Bothell, WA) machine with a high resolution, 7.5MHz hockey stick linear probe. Dynamic evaluation was performed in real time. RESULTS: Surgery was performed after the ultrasonographic evaluation. Sonographic diagnosis and intraoperative findings were correlated. Ultrasonographic findings show tendon discontinuity, gaps, and fluid collection. CONCLUSION: We conclude that ultrasonography is helpful in evaluating and managing acute tendon injury. Especially, in cases of completely lacerated tendon, ultrasonography can identify the location of the proximal tendon stump and partial lacerated tendon, ultrasonographic diagnostic tool can decrease misdiagnosis.
Child ; Hand ; Hockey ; Humans ; Tendon Injuries ; Tendons ; Unconscious (Psychology)

The risk of pressure sores is greatest in patients who are elderly, debilitated, incontinent, paralyzed or unconscious. During surgery, patients are immobile and they are unable to perceive the discomfort of prolonged pressure, and the anesthetized patient lacks a protective mechanism to prevent pressure sores. We report here on the case of a 6-year-old boy who presented with a pressure sore of the contralateral helical rim after middle ear surgery. Despite 10 days of treatment, the dermatological examination showed skin necrosis over the helical rim. He required debridement of the skin and the defect was subsequently reconstructed with a split-thickness skin graft.
Aged ; Child ; Debridement ; Ear ; Ear, Middle ; Humans ; Necrosis ; Pressure Ulcer ; Skin ; Transplants ; Unconscious (Psychology)

BACKGROUND/AIMS: The clinical usefulness of nasogastric tube insertion in poisoning patients is controversial. This study compared the incidence of aspiration pneumonia between patients with or without nasogastric tubes. METHODS: We retrospectively reviewed the clinical reports of poisoning patients seen from January 2006 to December 2007. We classified the patients into groups with and without nasogastric tube insertion and evaluated the incidence and risk factors of aspiration pneumonia. RESULTS: Ultimately, 63 patients were included. The incidence of aspiration pneumonia was higher in patients with nasogastric tube insertion than in patients without nasogastric tube insertion (conscious patients: 58.8% vs. 11.8%, p=0.010; unconscious patients: 72.2% vs. 27.3%, p=0.027). Nasogastric tube insertion was a significant risk factor for developing aspiration pneumonia (odds ratio 3.54; 95% confidence interval 1.74~12.34). CONCLUSIONS: Nasogastric tube insertion did not prevent aspiration pneumonia, but was a risk factor. The results have implications in the development of a hypothesis about why a nasogastric tube increases the risk of aspiration pneumonia. This study has important limitations stemming mostly from other compounding factors and its retrospective design.
Charcoal ; Humans ; Incidence ; Pneumonia, Aspiration ; Retrospective Studies ; Risk Factors ; Unconscious (Psychology)

Traditional nutrition education has not been shown to consistently produce behavior change. While it has been suggested that using emotion-based messages may be a better way to influence nutrition behavior change, this has not been well tested. Producing emotion-based messages is a multi-step process that begins with exploring subconscious barriers to behavior change rather than the more obvious and typically reported barriers. The purpose of this research was to uncover the emotional reasons, sometimes referred to as emotional pulse points, for mothers' choosing or not choosing to have more family meals. This would then serve as the first step to developing emotion-based messages promoting the benefits of family meals. Five focus group interviews were conducted with 51 low-income Black (n=28) and white (n=23) mothers. Metaphorical techniques were used to determine underlying feelings toward family and family meals. Discussions were video-taped, transcribed, and manually analyzed using a content-driven, immersion/crystallization approach to qualitative data analysis. Four themes emerged around the definition of family: acceptance, sharing, chaos, and protective/loyal. Some mothers felt mealtime was merely obligatory, and described it as stressful. Some reported a preference for attending to their own needs instead of sitting down with their children, while others felt that mealtime should be used to interact with and educate children and felt guilty when they were not able to provide family meals. Three themes emerged around feelings towards having or not having family meals: unimportant, important, and guilty. When explored further, mothers indicated that using the feeling of guilt to encourage family meals might be effective. Data obtained are being used to develop innovative, emotion-based messages that will be tested for effectiveness in promoting family meals.
Child ; Focus Groups ; Guilt ; Humans ; Meals ; Metaphor ; Mothers ; Resin Cements ; Statistics as Topic ; Unconscious (Psychology)

Post-clipping intraparenchymal hemorrhage of the contralateral hemisphere is a very unusual phenomenon in a patient with aneurysmal subarachnoid hemorrhage, unless there is an underlying condition. We report a complicated case of 47-year-old man, who underwent uneventful clipping of ruptured aneurysm and experienced vasospasm two weeks later. Vasospasm was treated by intra-arterial nimodipine and systemic hyperdynamic therapy. One week thereafter, he became unconscious due to intraparenchymal hemorrhage on the anterior border-zone of contalateral hemisphere, but intraoperative and pathologic findings failed to disclose any vascular anomaly. We suggest that the anti-spastic regimens cause local hemodynamic redistribution through the vasodilatory effect and in turn, resulted in such an unexpected bleeding.
Aneurysm ; Aneurysm, Ruptured ; Hemodynamics ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Middle Aged ; Nimodipine ; Subarachnoid Hemorrhage ; Unconscious (Psychology)

BACKGROUND: Because the sternomental distance (SMD) is evaluated in conscience patients and in the sitting position, this could change under general anesthesia, which is a state that the patient is unconscious and fully relaxed in the supine position. Increasing age also affects the SMD. We investigated the change in the SMD with the patients under general anesthesia and we also investigated the effect of age on the SMD. METHODS: A total of 108 patients were allocated to Group Y (20-30 yr), Group M (31-50 yr) and Group O (51-70 yr). The SMD, as measured when the patients were awake and sitting, was defined as baseline. The SMD was measured in the supine position, the shoulder-suppressed supine position, at the time of loss of consciousness (LOC), 4 min after vecuronium administration and in the sniffing position. The percent change of the SMD (%) was defined as (the baseline SMD - the measured SMD)/the baseline SMD x 100. RESULTS: Compared with the baseline, the SMD decreased significantly in the supine position, the shoulder-suppressed supine position, at the time of LOC, during neuromuscular blockade and in the sniffing position in all the groups. Group O showed a shorter SMD than did Groups Y and M for all the measurements. There was no significant difference in the percent change of the SMD between the groups. CONCLUSIONS: This study demonstrated that the SMD was significantly reduced by the supine position, the sniffing position, at the time of loss of consciousness and during neuromuscular blockade with the patient under general anesthesia and also with the increasing age of the patient.
Anesthesia, General ; Conscience ; Humans ; Neuromuscular Blockade ; Supine Position ; Unconscious (Psychology) ; Unconsciousness ; Vecuronium Bromide

Nesidioblastosis is a rare disorder, and it usually considered as a cause of neonatal hyperinsulinemic hypoglycemia. A 35 year-old-woman with hyperinsulinemic hypoglycemia was admitted in an unconscious condition. Abdominal CT, pancreas MRI and celiac angiography with an intra-arterial calcium stimulation test revealed a suspicious insulin-producing tumorous lesion in the head of pancreas. The patient underwent enucleation of the pancreas head tumor under the initial diagnosis of insulinoma. However, the tumor was confirmed histologically as nesidioblastosis that showed ductoendocrine proliferations and numerous small endocrine cell groups. Nesidioblastosis is classified into a focal type and a diffuse type, which are characterized by different clinical outcomes. The patient in our case showed a normal blood glucose level after operation, which is often the case for the focal type. Herein, we report this very rare case of adult nesiodioblastosis that was successfully treated by surgical resection.
Adult ; Angiography ; Blood Glucose ; Calcium ; Endocrine Cells ; Head ; Humans ; Hyperinsulinism ; Hypoglycemia ; Insulinoma ; Nesidioblastosis ; Pancreas ; Unconscious (Psychology)

Insulinoma is a rare endocrine tumor that frequently causes neurologic symptoms. We report a case of a 17-year-old man with hypersomnia and abnormal behavior lasting for 10 months. He had recurrent attacks of hypersomnia that lasted for up to 36 hours and of unconscious wandering mimicking an ictal or postictal state. Hypoglycemia was documented (30 mg/dL) and insulinoma was found at the most-recent episode. Clinicians should be aware that hypersomnia and unconscious wandering can present in association with hypoglycemia.
Adolescent ; Disorders of Excessive Somnolence ; Humans ; Hypoglycemia ; Insulinoma ; Neurologic Manifestations ; Unconscious (Psychology)