Case Of Crush Syndrome Research Articles

REGENERATIVE EFFECTS OF REGIONAL INTRODUCTION OF MESENCHYMAL STROMAL HUMAN CELLS IN HYALURONIC ACID GEL UNDER EXPERIMENTAL COMPRESSION TRAUMA OF SOFT TISSUES

Relevance. In emergency situations, cases of crush syndrome with extensive ischemic damage of soft tissues often occur due to prolonged compression from damaged buildings, structures, rocks, damaged transport, mines, etc. Unmet medical need for providing care to victims with severe compression trauma determines the importance of research on the development of new pathogenetically justified treatments of postischemic disorders. The positive role of multipotent mesenchymal stromal cells has been proved in the process of posttraumatic regeneration of skeletal muscles. Intention. To reveal morphological features of skeletal muscles in severe compression trauma after the introduction of multipotent mesenchymal stromal cells in the hyaluronic acid gel into the damaged tissues. Methods. The object of the study was an experimental model of a continuous (7-hour) static compression (squeezing force 10–12 kg/cm 2 ) of the soft tissues of the hip by metal vices in sexually mature white outbred male rats with body mass of 300– 340 g. Three hours after the vices removal, rats in the experimental group received a single fan-shaped injection of suspended cultured multipotent mesenchymal stromal cells of human adipose tissue (1.5 • 10 6 cells) in 0.5 ml of 1.75 % hyaluronic gel solution (Aestetic Dermal S.L., Spain) intramuscularly into the compression region. Control animals under similar conditions were injected with an 0.9 % solution of sodium chloride. For reference parameters, biomaterial from intact rats was used. In 7, 14 and 28 days after decompression by the light-optical method, the histological sections of the biomaterial from the compression region were examined. Results and Discussion . It has been established that implantation of cultured multipotent mesenchymal stromal cells in soft tissues damaged by mechanical compression contributes to an early reduction of necrobiotic changes in the zone of muscle compression, accelerated recovery of microcirculation and reparative regeneration of muscle fibers with an active new growth of muscle tissue. Seven, 14 and 28 days after exposure, the relative area of muscle fibers was 23 35.6 % (p<0.05) higher than in control animals and achieved 62.4–85.6 %. Conclusion. It has been suggested that cultured multipotent mesenchymal stromal cells in a cellular carrier locally transplanted into the lesion region can be considered as a fruitful way to create effective concentrations of interstitial growth factors and cytokines that regulate severity of the inflammatory reaction, angiogenesis and reparative processes resulted from massive mechanical compression of soft tissues.

Estimation of the Demand for Hospital Care After a Possible High-Magnitude Earthquake in the City of Lima, Peru.

A probabilistic model was designed that included the following variables: demand for hospital care; time of arrival at the hospitals; type of medical treatment; reason for hospital admission; and the need for specialized care like hemodialysis, blood transfusions, and surgical procedures. The values for these variables were obtained through a literature search of the databases of the MEDLINE medical bibliography, the Cochrane and SciELO libraries, and Google Scholar for information on earthquakes over the last 30 years of over magnitude 6.0 on the moment magnitude scale. If a high-magnitude earthquake were to occur in Lima, it was estimated that between 23,328 and 178,387 injured would go to hospitals, of which between 4,666 and 121,303 would require inpatient care, while between 18,662 and 57,084 could be treated as outpatients. It was estimated that there would be an average of 8,768 cases of crush syndrome and 54,217 cases of other health problems. Enough blood would be required for 8,761 wounded in the first 24 hours. Furthermore, it was expected that there would be a deficit of hospital beds and operating theaters due to the high demand. Sudden and violent disasters, such as earthquakes, represent significant challenges for health systems and services. This study shows the deficit of preparation and capacity to respond to a possible high-magnitude earthquake. The study also showed there are not enough resources to face mega-disasters, especially in large cities. Bambarén C , Uyen A , Rodriguez M . Estimation of the demand for hospital care after a possible high-magnitude earthquake in the City of Lima, Peru. Prehosp Disaster Med. 2017;32(1):106-111.

長時間の胡坐を契機に急性傍脊柱筋コンパートメント症候群，クラッシュ症候群を来した1例(A case of crush syndrome with acute paraspinal compartment syndrome caused by prolonged sitting in a cross–legged position)

要旨長時間の胡坐という静的な機序により急性傍脊柱筋コンパートメント症候群とクラッシュ症候群を発症した初めての症例を経験したので報告する。症例は27歳の男性で，基礎疾患に双極性障害と不眠症がある。新規に処方された向精神薬を服用後に胡坐での前傾姿勢で入眠し，13時間後に腰背部の激痛により同一姿勢のまま覚醒して当院へ搬送された。来院時ショック状態であり，下肢，鼠径部外側にそれぞれ発赤，腫脹を認め，腰背部の傍脊柱筋は両側ともに硬直がみられた。また，両下肢は完全麻痺であった。検査所見では横紋筋融解症，急性腎傷害，高カリウム血症，代謝性アシドーシス，ミオグロビン尿を認めた。単純CTでは下肢，臀部に加えて両側の多裂筋に低吸収域を呈し，MRI T2強調像でも同部位に高信号像を認めた。各筋区画内圧は下肢，多裂筋で上昇していたため，下腿，大腿に対する減張切開術後にICUへ入院した。第2病日に臀部への減張切開術を，第19病日に感染制御困難となったため右下腿切断術をそれぞれ施行し，転院時には両下肢は完全麻痺のままであった。

Novel application of vacuum sealing drainage with continuous irrigation of potassium permanganate for managing infective wounds of gas gangrene.

Traumatic gas gangrene is a fatal infection mainly caused by Clostridium perfringens. It is a challenge to manage gas gangrene in open wounds and control infection after debridement or amputation. The aim of the present study was to use vacuum sealing drainage (VSD) with continuous irrigation of potassium permanganate to manage infective wounds of gas gangrene and observe its clinical efficacy. A total of 48 patients with open traumatic gas gangrene infection were included in this study. Amputations were done for 27 patients, and limb salvage procedures were performed for the others. After amputation or aggressive debridement, the VSD system, including polyvinyl alcohol (PVA) foam dressing and polyurethane (PU) film, with continuous irrigation of 1:5000 potassium permanganate solutions, was applied to the wounds. During the follow-up, all the patients healed without recurrence within 8-18 months. There were four complications. Cardiac arrest during amputation surgery occurred in one patient who suffered from severe septic shock. Emergent resuscitation was performed and the patient returned to stable condition. One patient suffered from mixed infection of Staphylococcal aureus, and a second-stage debridement was performed. One patient suffered from severe pain of the limb after the debridement. Exploratory operation was done and the possible reason was trauma of a local peripheral nerve. Three cases of crush syndrome had dialysis treatment for concomitant renal failure. In conclusion, VSD can convert open wound to closed wound, and evacuate necrotic tissues. Furthermore, potassium permanganate solutions help eliminate anaerobic microenvironment and achieve good therapeutic effect on gas gangrene and mixed infection. VSD with continuous irrigation of potassium permanganate is a novel, simple and feasible alternative for severe traumatic open wounds with gas gangrene infection.

長時間の胡坐が原因で発症したクラッシュ症候群と肺塞栓症の1例

向精神薬の服用や薬物過量服薬に伴う意識障害により，同一姿勢で四肢を長時間圧迫し横紋筋融解症やクラッシュ症候群，神経麻痺を来す報告は散見されるが，上記に加えて肺塞栓症を併発した稀な症例を経験したので報告する。症例は73歳の男性で，躁鬱病の外来治療中に内服薬が変更され過鎮静の状態となり，胡坐の状態で約10時間就眠した。覚醒後より右下肢の運動障害，右臀部から大腿部の腫脹と疼痛がみられ当院に救急搬送された。搬送時の意識状態はJCS 1で呼吸循環状態は安定していたが，身体所見上，右臀部から大腿部の腫脹と圧痛，坐骨神経麻痺を認めた。診察中に呼吸困難と酸素飽和度低下，意識障害を来したが，数分間で改善がみられた。病歴聴取で上記の発症状況が判明したため，CT血管造影検査を施行したところ，右中殿筋から大腿四頭筋の筋腫脹と肺塞栓症，右ヒラメ静脈内の深部静脈血栓症を認めた。また血液検査ではCPK 52,700 U/lと上昇しており，右下肢の長時間圧迫に伴うクラッシュ症候群，坐骨神経麻痺，右下腿深部静脈血栓症および肺塞栓症と診断し，十分な輸液と抗凝固療法を開始した。その後，横紋筋融解症や腎機能障害は改善し，下肢深部静脈血栓症や肺塞栓症の再発はなかった。薬物服用後に意識障害を来し，とくに下肢の長時間圧迫によるクラッシュ症候群を発症した症例では，経過中に肺塞栓症を合併する恐れがあるため注意を要する。

Fator de inibição da migração de macrófagos e interleucina-6 na síndrome de esmagamento: analogia com gravidade? Relato de casos

Macrophage migration inhibitory factor (MIF) is a multifunctional cytokine involved in a broad-spectrum pathological events relevant to the immune system. Interleukin-6 (IL-6) is a proinflammatory cytokine that plays an important role in the initial inflammatory response to trauma and the development of early and late multiple organ dysfunction syndrome (MODS). Crush syndrome has been described as the systemic manifestation of muscle cell damage resulting from pressing or crushing. There are few data about MIF and IL-6 in crush syndrome. The aim of this study was to report four cases of crush syndrome, measuring seric levels of MIF and IL-6 and its correlation with severity. Four patients suffering from crush syndrome after an accident with an explosive artifact were enrolled in the study. APACHE II score was checked at admission. It was collected serum sample of these patients during six consecutive days. Serum MIF, IL-6 and creatine kinase (CK) were measured. Sepsis-related organ failure assessment (SOFA) score was evaluated concomitantly. Data were analyzed. The variations observed in the CK measures were followed by alterations in the cytokines' level and at the SOFA score, suggesting interdependence between those factors. Other articles have already demonstrated similar results. Although the use of cytokines as biomarkers of severity in trauma is matter of interest, we need large studies with a higher number of patients to validate this observation.

Rhabdomyolysis.

Rhabdomyolysis.

長時間の砕石位によりｃｒｕｓｈ ｓｙｎｄｒｏｍｅとなった１例

長時間の砕石位によりcrush syndromeとなった1例を経験した. 症例は66歳の男性, 1995年, 直腸癌に対し低位前方切除術施行, 1998年8月3日直腸癌骨盤内再発により腹会陰式直腸切断術を施行. 手術開始より砕石位とし, 会陰部操作の際下肢の屈曲を強化, その1時間後より血圧低下, 脈拍上昇をきたした. 手術時間は14時間33分 (出血量4,390g). 手術終了より数時間後に下肢の変色に気づき, 乏尿を認め血清Cre, K値は上昇し続けた為, 持続的血液濾過透析を開始, 第22病日に透析を離脱, 全身状態が改善した. 腓骨神経麻痺が残り現在は杖歩行可能である. 文献的検索では砕石位によるcompartment syndromeのうち筋膜切開施行29例中, 腎不全発症率は0～20%と低率であるが, 神経麻痺は75%以上に認めた. 砕石位手術の際は, crush syndromeを念頭にいれ, 砕石位は必要時のみに留め, 予防に努めることが重要であると思われた.

Burn injuries in the 1995 Hanshin-Awaji earthquake

In the 1995 Hanshin-Awaji earthquake, 504 deaths were listed as fire related, although many of the victims may have been crushed or suffocated before they were burned. Census data related to surviving burn victims, however, were unknown. This study was designed to examine the medical requirements of those burn patients following the earthquake. Medical records of 2718 patients with injuries admitted to 95 hospitals during the 15 days after the earthquake were retrospectively reviewed. Only 44 patients (1.9 per cent) were hospitalized with burns. Scalds with less than 20 per cent total burn surface area (TBSA) were mainly observed; flame burns from earthquake-associated fires were rare. Morbidity rates increased in patients over 40 years old. Associated injuries were observed in 11 cases. These included three soft tissue injuries, one rib, three spine, three pelvis and two extremity fractures, and two cases of crush syndrome. Intensive care was required for only 10 patients, five of whom were transferred to hospitals that were undamaged or outside the earthquake zone. No relationship was noted between the number of burned houses and that of hospitalized burn patients. These results suggest that the number of burn patients requiring medical care was less than might have been expected in view of the total number of fire-related deaths in this urban earthquake.

A Case of Crush Syndrome with Multiple Organ Failure and Massive Intestinal Necrosis

A case of crush syndrome with multiple organ failure and massive intestinal necrosis is reported.A 50-year-old female suffered severe crush injury to abdomen and both thighs in the 1995 Great Hanshin Earthquake, Japan. Her subsequent course was complicated by acute renal failure, disseminated intravascular coagulation, paralytic ileus, lung abscess and hepatic failure. She did not improved regardless of intensive treatment including blood purification, mechanical ventilation. Fasciotomy was not performed.Paralytic ileus prolonged, but small bowel injury was not identified by CT scanning. Repeated physical examination didn't show absolute indications for surgery. Later intestinal necrosis was recognized by ultrasonography, and massive intestinal resection was performed on 28th hospital. day.Postoperative course was good. Rehabilitation made her walked again. Conservative local treatment of crush injury bore the good outcome.In a case of prolonged paralytic ileus after crush injury for abdomen, small bowel injury should be considered regardless of diagnostic tests.

DELAYED COMPLICATIONS OF ECT – "CRUSH SYNDROME"

A case of crush syndrome following ECT is reported. It emphasizes the need to anticipate such complications. There are probably other delayed complications in which the relationship to ECT has not yet been recognized. An increased awareness of their potential occurrence is essential if earlier and more adequate management of them is to result. Careful autopsy studies are necessary for the broadening of our knowledge in these areas. "Was man weiss, man sieht."

The crush syndrome in obstetrics: Report of fatal case

1.1. A case of crush syndrome following premature separation of the placenta is reported.2.2. The available information on the etiology, mechanism, and treatment of this condition is reviewed.3.3. Suggestions for treatment based on available case reports are given.