Sistema de presión negativa en loxoscelismo cutáneo-visceral. Reporte de un caso

Introducción: Las mordeduras por araña parda pueden manifestarse desde una simple lesión dérmica en el área de la mordedura, hasta formas graves, con falla orgánica múltiple. Caso Clínico: presentamos el caso de una paciente con mordedura por araña parda, quien presenta inicialmente lesiones dérmicas sin necrosis, evolucionando con áreas de necrosis y el desarrollo de síndrome compartimental de extremidad, sepsis, choque séptico y falla renal. Mejora tras manejo intensivo, anti veneno y colocación de terapia de presión negativa (TPN) en herida, conservando la extremidad afectada integra y recuperando la función renal. Discusion: Este caso en particular presenta los tres tipos de manifestaciones que se generan en el loxoscelismo, las cuales son una forma de presentación poco frecuente. El tratamiento con TPN se ha introducido como una terapia poderosa, no farmacológica para ayudar a acelerar el proceso de cicatrización de heridas y puede ser de utilidad en pacientes con mordedura de araña (loxoscelismo).

Introduction: The brown spider bites have the peculiarity of manifesting from a simple skin lesion in the area of the bite, to severe forms, with multiple organic failure. Clinical Case: We present the case of a patient with a brown spider bite, initially presenting dermal lesions without necrosis, evolving with areas of necrosis and the development of compartment syndrome of extremities, sepsis, septic shock and renal failure. Improvement after intensive management and installation in negative pressure therapy wound (NPT), keeping the affected limb integrated and recovering renal function. Discussion: This case in particular presents the three types of manifestations that are generated in loxoscelism, which are a rare form of presentation. The NPT treatment has been introduced as a powerful, non-pharmacological and physical therapy to help accelerate the wound healing process and may be useful in patients with spider bites.

Compartment Syndrome Secondary to Bothrops spp. Envenomation in Triângulo Mineiro, Region, Minas Gerais, Brazil

ABSTRACT Background: Snakebite is a neglected global health problem with high morbidity. We describe compartment syndrome (CS) cases related to snakebites by Bothrops spp. Methods: The medical records of patients admitted with snakebites envenomation were reviewed. Results: Of 47 patients with Bothrops spp. envenomation (4 male; mean age: 42 years), 7 (15%) developed CS. The mean time to antivenom administration was 9.5 hours. The time to fasciotomy was variable. Seven patients developed infection and four had acute kidney injury. Conclusions: The incidence of CS is higher than that reported previously. This may be due to the clinical severity and long delay before administering antivenom.

Compartment Syndrome following Intramedullary Nail Fixation in Closed Tibial Shaft Fractures

@#Introduction: Compartment syndrome complicating intramedullary nailing of closed tibia fractures has been described as early as the 1980s, but currently remains less described in literature compared to compartment syndrome directly following trauma. This study aims to review this potentially disabling complication and highlight the importance of timely diagnosis and management of compartment syndrome following fracture fixation, not just after fracture itself, via a review of three cases. Material and methods: A retrospective study of a series of three cases was conducted. The type of fracture, wait time to fixation, surgery duration, reaming, size of nail implant used, tourniquet time, and surgical technique were recorded. Time to diagnosis of compartment syndrome, compartment pressure if available, extent of muscle necrosis, reconstructive procedures performed, and post-operative complications were analysed. Results: The three cases following high-energy trauma from road traffic accidents presented from January to May 2010. Compartment syndrome was diagnosed clinically for all cases, between one to six days post-operatively and supported by elevated compartment pressure measurements in two of the three cases. Conclusion: This study advocates thorough clinical monitoring and maintaining strong clinical suspicion of compartment syndrome in patients even after intramedullary nail fixation of tibial shaft fractures to achieve timely limbsalvaging intervention. While intercompartmental pressure can be used to aid in diagnosis, we do not advise using it in isolation to diagnose compartment syndrome. Tendon transfer improves functional mobility and provides a good result in patients with severe muscle damage, while skin grafting sufficient in patients with minimal muscle damage.

Mordeduras de ofidios en mano pediátrica y sus complicaciones locales / Snake bites in pediatric hand and their local complications / Mordidas de serpentes de mão pediátricas e suas complicações locais

Introducción: el envenenamiento por mordedura de ofidios es reconocido como un problema de salud pública según la Organización Mundial de la Salud. La baja incidencia sumada a la diversidad de presentaciones clínicas, edades, topografías afectadas, así como los diferentes protocolos en la bibliografía existente sobre algunos aspectos del tratamiento, hacen difícil el manejo sistematizado de estos pacientes. El objetivo de este trabajo es realizar una revisión sistemática de la literatura sobre mordedura de serpientes en pacientes pediátricos con afectación en mano y miembro superior, haciendo hincapié en la conducta frente las complicaciones loco-regionales. Por importancia y frecuencia destacamos al síndrome compartimental, las flictenas y las infecciones. Metodología: se realizó una búsqueda bibliográfica en MedLine/PubMed con las palabras clave: "Snake Bite hand Children" y "Snake Bite compartimental syndrome". Se incluyeron los artículos publicados en los últimos 10 años (2012 al 2022). Resultados: la búsqueda de artículos ante las palabras "Snake Bite hand Children" resultó en 20 articulos y la busqueda ante las palabras "Snake Bite compartimental syndrome" derivó en 34. Luego de aplicar los criterios de inclusión y exclusión se obtuvieron 30 artículos para el análisis. Conclusiones: la población pediátrica se encuentra más expuesta a las mordeduras por serpientes y a su vez a presentar lesiones más severas. El tratamiento del síndrome compartimental continúa siendo un tema de debate. El veneno inoculado puede simular un síndrome compartimental que puede revertir sin fasciotomías con el tratamiento adecuado. Igualmente, ante síntomas y signos claros de síndrome compartimental se sugiere realizar fasciotomías frente a las graves secuelas potenciales. Ante la aparición de flictenas, el destechado cuidadoso de la misma es un tratamiento adecuado. La mayoría de los autores coinciden con el tratamiento profiláctico con antibioticoterapia.

Introduction: Ophidian bite poisoning is recognized as a public health problem by the World Health Organization. The low incidence added to the diversity of clinical presentations, ages, affected topographies, as well as the different protocols in the existing literature on some aspects of treatment, make the systematized management of these patients difficult. The aim of this work is to carry out a systematic review of the literature on snakebite in pediatric patients with hand and upper limb involvement, with emphasis on the management of loco-regional complications. In terms of importance and frequency, we highlight compartment syndrome, phlyctenas and infections. Methodology: a literature search was carried out in MedLine/PubMed with the keywords: "Snake Bite hand Children" and "Snake Bite compartment syndrome". Articles published in the last 10 years (2012 to 2022) were included. Results: the search for articles with the words "Snake Bite hand Children" resulted in 20 articles and the search for the words "Snake Bite compartment syndrome" resulted in 34 articles. After applying the inclusion and exclusion criteria, 30 articles were obtained for the analysis. Conclusions: the pediatric population is more exposed to snake bites and in turn to present more severe lesions. The treatment of compartment syndrome continues to be a subject of debate. Inoculated venom can simulate a compartment syndrome that can be reversed without fasciotomies with proper treatment. Likewise, in the presence of clear symptoms and signs of compartment syndrome, fasciotomies are suggested because of the serious sequelae generated. In the event of the appearance of phlyctenas, careful unroofing of the phlyctenas would be an appropriate treatment. Most authors agree with prophylactic treatment with antibiotic therapy.

Introdução: O envenenamento por mordidas ofídias é reconhecido como um problema de saúde pública pela Organização Mundial da Saúde. A baixa incidência, juntamente com a diversidade de apresentações clínicas, idades, topografias afetadas, bem como os diferentes protocolos da literatura existente sobre alguns aspectos do tratamento, tornam difícil o gerenciamento sistemático desses pacientes. O objetivo deste trabalho é realizar uma revisão sistemática da literatura sobre mordida de cobra em pacientes pediátricos com envolvimento de mãos e membros superiores, com ênfase no gerenciamento de complicações loco-regionais. Em termos de importância e freqüência, destacamos a síndrome compartimental, as flectenas e as infecções. Metodologia: foi realizada uma pesquisa bibliográfica no MedLine/PubMed com as palavras-chave: "Snake Bite hand Children" e "Snake Bite compartment syndrome". Os artigos publicados nos últimos 10 anos (2012 a 2022) foram incluídos. Resultados: a busca de artigos usando as palavras "Snake Bite hand Children" resultou em 20 artigos e a busca das palavras "Snake Bite compartment syndrome" resultou em 34 artigos. Após a aplicação dos critérios de inclusão e exclusão, foram obtidos 30 artigos para análise. Conclusões: a população pediátrica está mais exposta às picadas de cobra e, por sua vez, a lesões mais graves. O tratamento da síndrome compartimental continua a ser motivo de debate. O veneno inoculado pode simular uma síndrome de compartimento que pode ser revertida sem fasciotomias com tratamento apropriado. Da mesma forma, se houver sinais e sintomas claros de síndrome compartimental, são sugeridas fasciotomias por causa das severas seqüelas. Se as flectenas aparecerem, o desenrolamento cuidadoso das flectenas seria um tratamento apropriado. A maioria dos autores concorda com o tratamento profilático com a antibioticoterapia.

Acute Compartment Syndrome of the Forearm and Hand due to Extravasation of Computed Tomography Contrast Material

Although Compartment Syndrome is a common surgical emergency with a plethora of aetiologies, Intravenous extravasation of Computed Tomography (CT) contrast medium causing acute compartment syndrome has been reported very rarely. We present a 61-year-old female who underwent abdominal CT with Intravenous contrast for irreducible, recurrent incisional hernia, presented with persistent excruciating pain and progressive multiple blister formation over the left forearm and hand following intravenous contrast material injection via the left dorsum of the hand. Clinical diagnosis of compartment syndrome was made, X-ray left forearm and hand confirmed soft tissue contrast extravasation. She was taken for emergency decompression fasciotomy of the left forearm and hand compartments, and later partial wound closure and split skin graft into remaining areas were carried out. Clinicians and radiologist should aware of this potential complication for its early recognition, management and prevention.

Síndrome compartimental: una presentación atípica como causa de la púrpura de Henoch-Schönlein / Compartment syndrome: an atypical presentation as a cause of Henoch-Schönlein purpura

Resumen: Introducción: en la literatura existen escasos reportes de caso del desarrollo de síndrome compartimental como una potencial complicación de la púrpura de Henoch-Schönlein. Caso clínico: se presenta el caso clínico de una paciente de 17 años con un cuadro de síndrome compartimental bilateral en pies como presentación atípica de la púrpura de Henoch-Schönlein, nunca antes descrita en la literatura. Conclusión: con una rápida sospecha diagnóstica y un tratamiento quirúrgico con fasciotomías, se consiguió preservar la viabilidad de las extremidades y su funcionalidad a los seis meses de seguimiento, a pesar de tratarse de una presentación sumamente atípica de la patología en cuestión.

Abstract: Introduction: there are few case reports available that describe compartment syndrome as a complication of Henoch-Schönlein purpura. Case report: we report the case of a 17-year-old patient with bilateral compartment syndrome of the foot as an atypical presentation of Henoch-Schönlein purpura. A case like this has not been reported before. Conclusion: although the patient had an extremely rare clinical presentation, the viability and functionality of the limbs was preserved even after six months of follow-up thanks to an early diagnosis and surgical treatment.

Manifestaciones cardiovasculares y síndrome compartimental asociado a mordedura por Phoneutria spp: Reporte de un caso / Cardiovascular manifestations and compartment syndrome associated with bite by Phoneutria spp: case report / Manifestações cardiovasculares e síndrome compartimental associadas à mordida de Phoneutria spp: Relato de caso

Se describen las características sobre el phoneutrismo a propósito de un caso. El phoneutrismo es el término con el que se conoce al accidente ocasionado por la mordedura de la araña phoneutria spp, la cual tiene una relevancia clínica dada por las características tóxicas de su veneno. Se presenta un caso de mordedura de la araña phoneutria spp de un paciente atendido en un hospital de alta complejidad de la ciudad de Medellín, Colombia, con manifestaciones cardiovasculares y hallazgos compatibles con un síndrome compartimental, lo cual es inusual en este tipo de arañas, por lo que se necesitó vigilancia en unidad de alta dependencia y fasciotomía cutánea. En Colombia este tipo de accidentes no son de reporte obligatorio, por tanto existe un alto riesgo de subregistro. Lo llamativo de este caso está en las manifestaciones cardiovasculares y la presencia de síndrome compartimental que no se ha descrito en la literatura con este subespecie de arañas.

The characteristics of phoneutrism are described in relation to a case. Phoneutrism is the term with which the accident caused by the bite of the phoneutria spp spider is known, which has clinical relevance given by the toxic characteristics of its venom. We present a case of a bite by the phoneutria spp spider in a patient treated at a high-complexity hospital in the city of Medellín, Colombia, with cardiovascular manifestations and findings compatible with compartment syndrome, which is unusual in this type of spiders, and required surveillance in a high dependency unit and cutaneous fasciotomy. In Colombia reporting this type of accident is not mandatory; therefore, there is a high risk of underreporting. What is striking about this case is the cardiovascular manifestations and the presence of compartment syndrome that has not been described in the literatura with this genre of spiders.

As características do fonutrismo são descritas em um relatório de um caso. Fonutrismo é o termo usado para descrever o acidente causado pela mordida da aranha Phoneutria spp, que é clinicamente relevante devido às características tóxicas de seu veneno. Apresentamos um caso de mordida de aranha por uma aranha Phoneutria em um paciente tratado em um hospital de alta complexidade na cidade de Medellín, Colômbia, com manifestações cardiovasculares e achados compatíveis com a síndrome compartimental, o que é incomum neste tipo de aranha, exigindo vigilância em uma unidade de alta de-pendência e fasciotomia cutânea. Na Colômbia, este tipo de acidente não é obrigatório, portanto, há um alto risco de subnotificação. O que é impressionante neste caso são as manifestações cardiovasculares e a presença da síndrome compartimental, que não foi descrita na literatura com esta subespécie de aranha.

Regional anesthesia for compartment syndrome as a complication of ECMO. Case report / Anestesia regional para síndrome compartimental como complicación de ECMO. Reporte de caso

Abstract We present the case of a patient intervened for mechanical mitral replacement, tricuspid annuloplasty, and correction of a total anomalous pulmonary venous return, which required Extracorporeal Membrane Oxygenation (ECMO) in the immediate postoperative period because of refractory cardiogenic shock. After withdrawal of the arterial cannula, the patient developed compartment syndrome of the right lower limb, requiring urgent intervention. Also, the patient went into respiratory failure, requiring support with high flow oxygen cannula. Given the patient's condition, general anesthesia was discarded. An ultrasound-guided popliteal block and sedation with dexmedetomidine and ketamine was performed instead, maintaining the high flow nasal cannula. Regional anesthesia along with dexmedetomidine and ketamine could be an alternative for a surgical procedure in patients with high risk of cardiovascular and respiratory complications.

Resumen Presentamos el caso de una paciente femenina sometida a remplazo de válvula mitral mecánica, anuloplastia y corrección de retorno venoso pulmonar anómalo total, quien requirió oxigenación con membrana extracorpórea (ECMO) en el postoperatorio inmediato debido a shock cardiogénico refractario. Una vez retirada la cánula arterial, la paciente desarrolló síndrome compartimental de la extremidad inferior derecha, requiriendo intervención urgente. Adicionalmente, presentó insuficiencia respiratoria que requirió soporte de oxígeno por cánula de alto flujo. En vista de la condición de la paciente se descartó la anestesia general, optando a cambio por un bloqueo poplíteo guiado por ultrasonido más sedación con dexmedetomidina y ketamina, manteniendo la cánula nasal de alto flujo. La anestesia regional junto con dexmedetomidina y ketamina puede ser una alternativa para procedimientos quirúrgicos en pacientes de alto riesgo cardiovascular y complicaciones respiratorias.

A Case of Kampo Medicine Treatment for Acute Antebrachial Compartment Syndrome in the Arm Caused with Percutaneous Coronary Intervention Via Radial Artery / 日本東洋医学雑誌

After percutaneous coronary intervention (PCI), the patient developed symptoms of pain, sensory impairment, paralysis, pallor of the skin, and pain during passive extension, and was diagnosed with PCI-induced antebrachial compartment syndrome. Since it was considered to be blood stasis and water stasis in Oriental medicine, we administered jidabokuippo and keishibukuryogan to the patient. Then the subjective and objective symptoms improved promptly, and the symptoms disappeared by the 10th day after the operation. The patient was able to discontinue jidabokuippo 14 days after the operation. It was suggested that the symptomatic treatment with Kampo medicine is effective for compartment syndrome.

The clinical value of dynamic detection of serum I-FABP, HBP, IL-1β in abdominal compartment syndrome patients secondary to severe acute pancreatitis / 中国医师杂志

Objective:To discuss the value of dynamic detection of serum intestinal fatty acid binding protein (I-FABP), heparin binding protein (HBP) and interleukin-1β(IL-1β) in early predicting and evaluating the severity of abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP) postoperative patients.Methods:The clinical data of 65 SAP patients treated in the Second Hospital of Anhui Medical University from July 2019 to Jan 2021 were retrospective analyzed. According to whether ACS has occurred, the patients were divided into non ACS group (48 cases) and ACS group (17 cases). The serum I-FABP, HBP and IL-1β of the two groups were dynamically monitored. Correlation analysis and receiver operating characteristic (ROC) curve were used to evaluate the efficacy and early prediction value of each observation index in evaluating the severity of SAP patients complicated with ACS.Results:There were no significant differences in age, sex, body mass index (BMI) and pathogenesis between the two groups (all P>0.05). The serum levels of C-reactive protein (CRP), white blood cell (WBC), Acute Physiology and Chronic Health Enquiry (APACHE-Ⅱ) score and intra-abdominal pressure (IAP) in ACS group were significantly higher than those in non ACS group (all P<0.05). The serum levels of I-FABP [(97.41±15.02)ng/ml vs (37.28±18.34)ng/ml, (103.32±18.40)ng/ml vs (56.96±19.12)ng/ml, (85.69±22.94)ng/ml vs (36.88±10.49)ng/ml], HBP [(92.19±14.59)ng/ml vs (24.56±10.96)ng/ml, (106.11±15.03)ng/ml vs (37.17±13.83)ng/ml, (128.11±16.43)ng/ml vs (68.94±15.91)ng/ml] and IL-1β[(15.78±1.44)pg/ml vs (11.26±1.34)pg/ml, (19.34±1.87)pg/ml vs (13.51±2.84)pg/ml, (20.95±1.96)pg/ml vs (16.03±1.04)pg/ml] on 1st, 4th, 7th day in ACS group were continuously and evidently higher than those in non ACS group ( P<0.01). Correlation analysis revealed that I-FABP, HBP and IL-1β were positively correlated with IAP ( r=0.745, 0.793, 0.770) and APACHE Ⅱ score ( r=0.510, 0.489, 0.445) (all P<0.01). ROC curve analysis showed that the AUC of early prediction by I-FABP, HBP and IL-1β on the occurrence of ACS were 0.846, 0.873 and 0.902 respectively, which were higher than the CRP (0.681), WBC (0.765) and APACHE Ⅱ score (0.795), the sensitivity and specificity can be significantly improved to 0.997 and 0.994 by parallel and series tests respectively combined with the three indicators. Conclusions:Dynamic detection of serum I-FABP, HBP and IL-1β has a certain clinical value in evaluating the severity of ACS in SAP patients. At the same time, early detection with serum I-FABP, HBP and IL-1β has high predictive power for ACS in SAP patients and the combined application of three has higher predictive value.

Clinical efficacy and prognostic influencing factors of open abdomen technique for acute pancreatitis with abdominal compartment syndrome / 中华消化外科杂志

Objective:To investigate the clinical efficacy and prognostic influencing factors of open abdomen technique for acute pancreatitis with abdominal compartment syndrome (ACS).Methods:The retrospective cohort study was conducted. The clinical data of 186 patients of acute pancreatitis with ACS who were admitted to 6 hospitals, including 65 cases in the 910th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army, 46 cases in the First Affiliated Hospital of Wenzhou Medical University, 33 cases in the Fujian Provincial Hospital, 31 cases in the Second Affiliated Hospital of Fujian Medical University, 7 cases in the People′s Hospital Affiliated to Quanzhou Medical College, 4 cases in the Shishi General Hospital, from January 2013 to December 2020 were collected. There were 142 males and 44 females, aged (43±8)years. Observation indica-tors: (1) patients conditions after being treatment with open abdomen technique; (2) analysis of clinical characteristics in patients with different treatment outcomes; (3) changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes; (4) influencing factors for prognosis of patients. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or the continuity correction chi-square test. Repeated measurement data were analyzed using the repeated ANOVA. Spearman correlation analysis was used for correlation analyses. The COX regression model was used for univariate analysis and COX regression model with forward regression was used for multivariate analysis. Results:(1) Patients conditions after being treatment with open abdomen technique. Intra-abdominal pressure, oxygena-tion index, levels of lactic acid and sequential organ failure score of the 186 patients were (23.3±1.9)mmHg (1 mmHg=0.133 kPa), (121±24)mmHg, (5.0±3.4)mmol/L and 10.4±3.6 before the treatment with open abdomen technique and (11.2±2.9)mmHg, (222±38)mmHg, (3.2±2.1)mmol/L and 4.4±2.3 at postoperative 168 hours, showing significant differences in time effects before and after the treatment ( Ftime=855.26,208.50, 174.91,208.47, P<0.05). (2) Analysis of clinical characteristics in patients with different treatment outcomes. Of the 186 patients, 166 cases survived and were discharged, and 20 cases died during hospitalization. Age, sequential organ failure score, duration of ACS and levels of lactic acid during hospitalization before the treatment with open abdomen technique were (41±7)years, 9.4±3.4, 13(10,21)hours and (4.2±0.6)mmol/L in surviving patients, versus (45±6)years, 11.5±2.4, 65(39,84)hours and (5.2±0.5)mmol/L in dead patients, respectively, showing significant differences between them ( t=-2.10, -2.71, Z=-5.36, t=-7.16, P<0.05). Duration of postoperative acute gastro-intestinal injury, duration of continuous renal replacement therapy, time to liberation from mech-anical ventilation, duration of vasoactive drugs therapy, cases undergoing early abdominal closure, cases without intestinal fistula or with postoperative high-order intestinal fistula and low-order intestinal fistula during hospitalization after the treatment with open abdomen technique were 4(2,6)days, 4(3,7)days, 34(21,41)days, 3(2,6)days, 126, 131, 23, 12 in surviving patients, versus 13(10,17)days, 10(8,18)days, 0(0,3)days, 8(6,12)days, 1, 2, 15, 3 in dead patients, respectively, showing significant differences between them ( Z=-5.60, -3.75, -3.64, -3.06, χ2=41.43, 45.86, P<0.05). (3) Changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes. The volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in surviving patients during hospitalization were (0.29±0.10)mL/(kg·h), (4.2±0.6)mmol/L, 0.0 kcal/(kg·d) and 9.4±3.4 before the treatment with open abdomen technique and (2.22±0.15)mL/(kg·h), (1.9±0.7)mmol/L, (20.7±2.9)kcal/(kg·d) and 3.7±2.2 at postoperative 168 hours. The above indicators in dead patients during hospitalization were (0.28±0.08)mL/(kg·h), (5.2±0.5)mmol/L, 0.0kcal/(kg·d) and 11.5±2.4 before the treatment with open abdomen technique and (0.28±0.09)mL/(kg·h), (7.7±0.8)mmol/L, (4.6±1.8)kcal/(kg·d) and 12.4±2.1 at postoperative 168 hours. There were significant differences in time effects in the above indicators in surviving patients and dead patients before and after the treatment with open abdomen technique ( Ftime=425.57, 188.59, 394.84, 37.52, P<0.05). There were interactive effects between the above indicators and the treatment outcome at different time points ( Finteraction=383.14, 233.04, 169.83, 36.61, P<0.05). There were signifi-cant differences in the change trends of the above indicators between the surviving patients and the dead patients during hospitalization ( Fgouprs=2 739.56, 877.98, 542.05, 240.85, P<0.05). (4) Influen-cing factors for prognosis of patients. Results of univariate analysis showed that age, sequential organ failure score, duration of ACS before surgery, procalcitonin, lactic acid, postoperative high-order intestinal fistula, abdominal hemorrhage, duration of postoperative acute gastrointestinal injury, duration of continuous renal replacement therapy, duration of vasoactive drugs therapy, early abdominal closure were related factors influencing prognosis of patients under-going treatment with open abdomen technique ( hazard ratio=1.07, 1.18, 1.39, 1.16, 8.25, 12.26, 2.83, 1.29, 1.56, 1.41, 0.02, 95% confidence interval as 1.00-1.15, 1.45-2.27, 1.22-1.57, 1.02-1.32, 1.75-38.90, 7.37-41.23, 1.16-6.93, 1.22-1.37, 1.23-1.99, 1.08-1.84, 0.00-0.16, P<0.05). Results of multivariate analysis showed that extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury were independent risk factors influencing prognosis of patients undergoing treatment with open abdomen technique ( hazard ratio=1.05, 7.95, 1.17, 95% confidence interval as 1.01-1.32, 2.05-30.87, 1.13-1.95, P<0.05) and early abdominal closure was an independent protective factor ( hazard ratio=0.10, 95% confidence interval as 0.01-0.89, P<0.05). Results of Spearman correlation analysis showed that duration of ACS was positively correlated with sequential organ failure score before surgery ( r=0.71, P<0.05). Conclusions:Open abdomen technique is effective for acute pancreatitis with ACS. Extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury are independent risk factors for prognosis of patients during hospitalization and early abdominal closure is an independent protective factor.

Research progress on the relationship between treatment and prognosis of intraperitoneal compartment syndrome in the pediatric intensive care unit / 中华危重病急救医学

Abdominal compartment syndrome (ACS) in children is a neglected complication in the pediatric intensive care unit (PICU) because the onset is insidious. ACS develops rapidly, involves the systemic organs, has a high mortality, and is a very serious complication in PICU. Timely and effective treatment of children with suspected or confirmed ACS is of significance to prevent the progression of the disease, improve prognosis and reduce mortality. However, most clinicians have limited understanding of the treatment measures for children with ACS and are unable to correctly choose appropriate treatment strategies, which affect the prognosis of children. To make the optimal treatment plan for ACS in children, the extent of elevated intra-abdominal pressure, the degree of organ dysfunction and the underlying diseases should be considered comprehensively. Mechanical ventilation, continuous renal replacement therapy (CRRT), and extracorporeal membrane oxygenation (ECMO) have a bidirectional effect on the occurrence and therapeutic effect of ACS. On the one hand, this article reviews the individualized treatment of ACS in PICU, so that more pediatricians could have a comprehensive and clear systematic understanding of the treatment plan of ACS in children. On the other hand, special treatment strategies and prognoses of ACS in PICU were also reviewed in this article, and the effects of intra-abdominal hypertension (IAH) on mechanical ventilation parameters, ECMO, and CRRT were illuminated. As well as the management strategy of mechanical ventilation, CRRT type in ACS children, and the treatment of ACS during ECMO were revealed.

Hemodynamic effects of increased intra-abdominal pressure in critically ill children

Abstract Objective: To evaluate the influence of intra-abdominal pressure on the cardiac index (CI) at different intra-abdominal hypertension grades achieved when performing an abdominal compression maneuver (ACM). Evaluating the effectiveness of the ACM in distending the left internal jugular vein (LIJV). Methods: Prospective observational study conducted in the PICU of a quaternary care teaching hospital. Participants underwent the ACM and the IAP was measured with an indwelling urinary catheter. At each IAH grade reached during the ACM, the CI was measured by transthoracic echocardiography and the LIJV cross-sectional area (CSA) was determined by ultrasonography. Results: Twenty-four children were included (median age and weight of 3.5 months and 6.37 kg, respectively). The median CI observed at baseline and during IAH grades I, II, III, and IV were 3.65 L/min/m2 (IQR 3.12−4.03), 3.38 L/min/m2 (IQR 3.04−3.73), 3.16 L/min/m2 (IQR 2.70−3.53), 2.89 L/min/m2 (IQR 2.38−3.22), and 2.42 L/min/m2 (IQR 1.91−2.79), respectively. A 25% increase in the LIJV CSA area was achieved in 14 participants (58%) during the ACM. Conclusion: The ACM significantly increases IAP, causing severe reversible impairment in the cardiovascular system and is effective in distending the LIJV in just over half of the subjects. Even low levels of HIA can result in significant cardiac dysfunction in children. Therefore, health professionals should be aware of the negative hemodynamic repercussions caused by the increased IAP.

Síndrome compartimental bilateral de pierna tras posición de litotomía prolongada: presentación de un caso clínico / Bilateral leg compartment syndrome after prolonged lithotomy position: clinical case report

INTRODUCCIÓN: El síndrome compartimental es una complicación infrecuente pero severa que puede aparecer ante una posición de litotomía prolongada y el uso de perneras. OBJETIVO: Presentar un caso de síndrome compartimental bilateral tras posición de litotomía prolongada asociada con el uso de perneras. MATERIAL Y MÉTODOS: Paciente varón de 43 años sometido a una cirugía urológica en posición habitual de litotomía durante un periodo de 6 horas. A las 2 horas de finalizar la cirugía, el paciente presentó dolor intenso y endurecimiento de compartimento anterior y lateral de ambas piernas, junto con una elevación de la creatina quinasa sérica (valor inicial de 109 U/L que se elevó hasta 7.689 U/L a las 12 horas) y una imposibilidad para la flexión dorsal pasiva de ambos tobillos. El paciente no sentía dolor en el resto de los compartimentos. RESULTADOS: Ante la sospecha de un síndrome compartimental anterolateral, se realizó fasciotomía bilateral urgente, y se observó una disminución de la perfusión muscular y mejoría de la misma tras apertura de la fascia. Se realizaron curas periódicas cada 48 horas, y se observó viabilidad del tejido hasta su cierre definitivo a los 4 días. A las 2 semanas, el paciente presentó fatiga ligera para la deambulación sin ayuda, con tumefacción en el compartimento lateral de ambas piernas. A los 10 meses de evolución, el paciente caminaba sin ayuda y con función muscular completa. CONCLUSIONES: El conocimiento de la asociación del síndrome compartimental y la cirugía laparoscópica prolongada es esencial para un diagnóstico precoz y un tratamiento quirúrgico inmediato, para evitar graves secuelas. Los buenos resultados de nuestro paciente se deben a la rápida actuación, ya que normalmente se suele demorar. Para evitar su aparición o disminuir su incidencia, la posición de litotomía debería limitarse a aquellos momentos de la cirugía en los que sea imprescindible, modificando la posición de las piernas cada dos horas en caso de cirugías prolongadas, para prevenir dicha complicación.

Compartment syndrome is a rare but severe complication resulting from a prolonged lithotomy position and the use of leg loops. PURPOSE: To present a case of bilateral compartment syndrome after prolonged lithotomy position associated with the use of leg loops. METHODS: A 43-year-old man underwent urological surgery in the usual lithotomy position for a 6-hour period. Two hours after the end of the surgery, the patient presented severe pain and stiffening of the anterior and lateral compartments of both legs, elevated serum creatine kinase levels (the baseline value of 109 U/L increased to 7,689 U/L at 12 hours), and inability for passive dorsiflexion of both ankles. The patient reported no pain in the other compartments. RESULTS: Suspicion of an anterolateral compartment syndrome resulted in an urgent bilateral fasciotomy; muscle perfusion was decreased, and it improved after fascial opening. Dressings were changed every 48 hours, and tissue viability was observed until the final closure at 4 days. At two weeks, the patient presented slight fatigue when walking with no assistance, in addition to swelling in the lateral compartment of both legs. Ten months after surgery, the patient walked with no assistance and with complete muscle function. CONCLUSION: Knowledge of the association between compartment syndrome and prolonged laparoscopic surgery is essential for an early diagnosis and immediate surgical treatment to avoid serious sequelae. In our patient, the good outcomes resulted from quick action, since diagnosis is often delayed. Limiting the lithotomy position to those surgical moments in which it is essential and changing the position of the legs every 2 hours during prolonged procedures can reduce the occurrence and incidence of compartment syndrome, preventing this complication.

Factores de riesgo para amputación en pacientes manejados con fasciotomía de miembro inferior en un centro de alta complejidad / Risk factors for amputation in patients managed with lower limb fasciotomy in a high complexity center

Resumen Introducción: El síndrome compartimental del miembro inferior tiene el potencial de causar morbilidad devastadora en los pacientes y altos riesgos médico-legales para los médicos involucrados en su tratamiento. Una vez instaurado, la fasciotomía se constituye como el único tratamiento efectivo. La pérdida de la extremidad afectada es su complicación con mayor carga de enfermedad. Existen pocas descripciones sobre factores de riesgo para la necesidad de amputación de miembro inferior luego de haber sido sometido a fasciotomía en pacientes con lesiones traumáticas. Materiales y Método: Se realizó un estudio retrospectivo, observacional, analítico en el cual se recolectó información de pacientes con traumatismo de miembro inferior que requirieron fasciotomía de muslo o pierna durante un periodo de 10 años en busca de factores que pudieron influir en la pérdida de la extremidad. Resultados: 21 pacientes cumplían los criterios de inclusión de los cuales 6 (28,57%) fueron amputados y 2 fallecieron (9,52%). La mayoría de los individuos fueron menores de 30 años y casi la totalidad del sexo masculino. Encontramos que el porcentaje de amputación parece verse afectado de manera estadísticamente significativa por factores como un International Severity Score (ISS) elevado (media de 24), las parestesias al ingreso, la realización de fasciotomía tardía (> 6 h), la reactividad muscular al momento de la cirugía, la infección del sitio operatorio y la reintervención por trombosis del injerto vascular. Conclusiones: Existen factores de riesgo que pueden indicar la pérdida de la extremidad inferior luego de ser sometido a fasciotomía en el contexto de trauma. Un seguimiento prospectivo y un mayor número de pacientes podrían permitir dilucidar más de dichos factores.

Introduction: The lower limb compartment syndrome has the potential to cause devastating morbidity in patients and high legal medical risks for doctors involved in its treatment. Once established, fasciotomy is the only effective treatment. The loss of the affected limb is the complication with a greater burden of disease. There are few descriptions of risk factors for the need for lower limb amputation after having undergone fasciotomy in patients with traumatic injuries. Materials and Method: A retrospective, observational, analytical study was conducted in which information was collected from patients with lower limb trauma that required thigh or leg fasciotomy for a period of 10 years in search of factors that could influence limb loss. Results: 21 patients met the inclusion criteria of which 6 (28.57%) were amputated and 2 died (9.52%). The majority of the individuals were under 30 years old and almost all of the male sex. We found that the percentage of amputation seems to be affected statistically significantly by factors such as a high ISS (mean of 24), paresthesia at admission, performing late fasciotomy (> 6 h), muscle reactivity at the time of surgery, postoperative SSI and reintervention by vascular graft thrombosis. Conclusions: We found risk factors that may indicate the loss of the lower limb after being subjected to fasciotomy in the context of trauma. A prospective follow-up and a greater number of patients could make it possible to elucidate more of these factors.

Intra-abdominal hypertension secondary to chronic diaphragmatic rupture in a dog / Hipertensão intra-abdominal secundária à ruptura diafragmática crônica em um cão

ABSTRACT: Intra-abdominal hypertension (IAH) is the persistent increase of intra-abdominal pressure (IAP) that could be caused by several pathologies. It is capable of promoting organ dysfunction, thereby increasing the mortality rate of human patients. As for cats and dogs, there are still few reports on how this pressure can be monitored and treated as a routine for admitted and hospitalized animals and on its relationship with the mortality of the patients. Therefore, the objective of this paper was to report a case of IAH secondary to chronic diaphragmatic rupture in a dog, which was treated with a temporary abdominal closure (TAC). A bitch was admitted to the veterinary hospital to undergo an elective ovariohysterectomy when it was diagnosed with a diaphragmatic rupture and displacement of the liver and intestinal loops in the chest. After repositioning these structures in the abdominal cavity, tension was observed in the abdomen. A temporary abdominal closure was then performed with a Bogota bag. Immediately after the surgery, the IAP was measured, presenting a value of 15 mmHg, indicating that there was an increase in intra-abdominal pressure. The animal was hospitalized, and IAP was monitored. After 24 hours, IAP was 5.8 mmHg when the Bogota bag was removed, and definitive celiorraphy was performed. The patient showed satisfactory clinical progress and was discharged 72 hours after the surgical procedure. The treatment used for IAH proved to be effective and contributed to the quick and satisfactory recovery of the patient.

RESUMO: A hipertensão intra-abdominal (HIA) é o aumento persistente da pressão intra-abdominal (PIA), podendo ser causada por diversas afecções e caraterizada por promover disfunções orgânicas, aumentando a taxa de mortalidade no homem. Em cães e gatos, ainda há poucos relatos da monitoração dessa pressão e do seu tratamento na rotina dos animais admitidos e internados, e sua relação com a mortalidade dos pacientes. Assim, objetivou-se relatar um caso de HIA secundária à ruptura diafragmática crônica em cão, a qual foi tratada com o fechamento abdominal temporário (FAT). Uma cadela foi admitida no hospital veterinário para realização de uma cirurgia de ovário-histerectomia eletiva, quando foi diagnosticada com ruptura diafragmática com fígado e alças intestinais deslocadas para o interior do tórax. Após reposicionamento dessas estruturas na cavidade abdominal, observou-se tensão no abdômen. Realizou-se então o fechamento abdominal temporário com bolsa de Bogotá. Imediatamente após o término da cirurgia, a PIA foi aferida e seu valor era de 15 mmHg, indicando aumento da mesma. O animal foi mantido internado e sua PIA monitorada. Após 24 horas seu valor era de 5,8 mmHg, quando a bolsa de Bogotá foi removida e realizada a celiorrafia definitiva. O paciente teve evolução clínica satisfatória e 72h após a cirurgia recebeu alta hospitalar. O tratamento utilizado para a HIA se mostrou eficaz, contribuindo para a rápida e satisfatória recuperação da paciente.

Shear wave elastography to evaluate the protective effect of testicular torsion fascial compartment decompression treatment on spermatogenesis / 中华超声影像学杂志

Objective:To investigate the feasibility of shear wave elastography (SWE) to evaluate the protective effect of testicular compartment decompression on spermatogenesis after testicular torsion reduction.Methods:Thirty-two rabbits were randomly divided into 4 groups: control group (S group), testicular torsion simple reduction group (I group), and testicular torsion reduction+ compartment decompression group (T group: T1 group, T2 group), 8 rabbits per group. After the complete testicular torsion model was established in the I and T groups, the I group was simply reperfused, and the T group was reperfused before decompression of the compartment. Rabbits in each group were kept for 30 days after successful modeling. Each group of rabbits underwent testicular fascia intracompartment pressure measurement and SWE examination before operation, after successful complete torsion modeling, after reperfusion and 30 days later. After the experiment, the surgical side testicles were taken for pathological examination.Results:After testicular torsion, the pressure of testicular fascia and the average Young′s modulus (Emean) of testicular tissue in each experimental group increased (all P<0.05), and further increased with the extension of torsion time (all P<0.05). After reperfusion, the testicular fascial compartment pressure and testicular tissue Emean value in group I further increased (all P<0.05), while the testicular fascial compartment pressure and testicular tissue Emean value in group T decreased (all P<0.05). Thirty days later, testicular fascial compartment pressure and testicular tissue Emean value in group I were higher than those in group T (all P<0.05), while Johnsen′s score of testicular tissue was lower than that in group T ( P<0.05), and testicular tissue apoptosis index and malondialdehyde content were higher than those in group T Group T (all P<0.05). Conclusions:Decompression of the testicular compartment has a protective effect on spermatogenesis after testicular torsion reduction. SWE can indirectly evaluate the severity of testicular compartment syndrome after testicular torsion and reduction, and the protective effect of compartment decompression on spermatogenesis.

Ultrasound evaluation of acute compartment syndrome: Based on healthy volunteers / 中华急诊医学杂志

Objective:To explore the application value of ultrasound in the early noninvasive monitoring of acute compartment syndrome model, and to provide reference for further clinical applications.Methods:This was a prospective self-controlled study. A model of healthy volunteers with acute compartment syndrome was established by cuff compression. The random method was used to determine the experimental side and the control side. The experimental side cuff was given 0, 20, 30, 40, 50, 60, 70, and 80 mmHg pressure in sequence, while the control side cuff was kept uncompressed at all times. Each pressure on the experimental side lasted for 5 min, during which the ultrasound was used to measure the blood flow waveform and vascular structure of the bilateral popliteal artery, popliteal vein and dorsal plantar artery. Statistical analysis was performed using repeated measures analysis of variance and multivariate analysis of variance.Results:The study included 25 healthy volunteers. There was no statistically significant difference in calf circumference and anterior tibial compartment thickness ( P = 0.314 and 0.678). During compression, the volunteers' heart rate and blood pressure were stable ( P = 0.235 and 0.358). On the experimental side, the maximum blood flow velocity of the popliteal artery during systole increased with the increase of pressure ( P<0.001), and the minimum blood flow velocity of the popliteal artery increased with the increase of pressure ( P<0.001). When pressurized by 30 mmHg, the maximum blood flow velocity of the popliteal artery on the experimental side was significantly higher than that on the control side [(73 ± 19) cm/s vs (59 ± 14) cm/s, P=0.023)]. When pressurized by 20 mmHg, the minimum blood flow velocity of the popliteal artery on the experimental side was significantly higher than that on the control side [(-28 ± 8) cm/s vs (-22 ± 6) cm/s, P=0.012)]. With the increase of pressure, the diastolic retrograde arterial flow ratio of the experimental side gradually increased ( P <0.001), and when the pressure was increased by 20 mmHg, the diastolic retrograde arterial flow ratio of the experimental side of the popliteal artery increased significantly [(0.42 ± 0.14) cm/s vs (0.30 ± 0.12) cm/s, P=0.009)]. The systolic prograde arterial flow ratio of the dorsal artery in the experimental side decreased with the increase of pressure ( P = 0.024). Conclusions:Increased limb compartment pressure can significantly change the arterial flow waveform of the proximal and distal arteries, and ultrasound can be used as an early monitoring tool for acute compartment syndrome.

Hipertensão intra-abdominal e síndrome compartimental abdominal: repercussões e tratamento clínico no paciente crítico / Intra-abdominal hypertension and abdominal compartment syndrome: repercussions and clinical treatment in critically ill patients

A hipertensão intra-abdominal e a síndrome compartimental abdominal foram durante muitas décadas mal compreendidas e dissociadas de suas repercussões clínicas. Trata-se de um distúrbio que pode levar à disfunção de múltiplos órgãos devido ao desequilíbrio circulatório desencadeado pelo aumento de pressão no compartimento abdominal. As manifestações envolvem os sistemas cardiovascular, respiratório, renal, nervoso e gastrintestinal e estão largamente relacionadas com o fator de morbimortalidade no paciente crítico. A despeito da importância clínica, a hipertensão intra-abdominal e à síndrome compartimental abdominal ainda são temas pouco dominados pelos médicos, e fazem-se necessários o reconhecimento precoce e o estabelecimento de estratégias clínicas objetivas no contexto de uma síndrome com desfecho tão desfavorável. Portanto, foi realizada uma revisão da literatura não sistematizada com objetivo de compreender os principais pontos sobre definições, prevalência, fatores de risco, fisiopatologia, diagnóstico e tratamento acerca da hipertensão intra-abdominal e a síndrome compartimental abdominal.

Intra-abdominal hypertension and abdominal compartment syndrome have been, for many decades, poorly understood and dissociated from their clinical repercussions. It is a disorder that can lead to organ dysfunction due to circulatory impairment triggered by increased pressure in the abdominal compartment. The manifestations involve cardiovascular, respiratory, renal, nervous, and gastrointestinal systems, and are widely associated with significant morbidity and mortality in critically ill patients. Despite their clinical importance, intra-abdominal hypertension and abdominal compartment syndrome are still not sufficiently known by physicians and, early recognition and the establishment of objective clinical strategies for managing these highly morbid syndromes are required. Therefore, a non-systematized review was carried out to understand the main points about definitions, prevalence, risk factors, pathophysiology, diagnosis, and treatment of intra-abdominal hypertension and abdominal compartment syndrome.

Structural anatomy of deep fascia, it’s implication in the pathogenesis of compartment syndrome of upper limbs and objective assessment of the effect of fasciotomy

Background: Deep fascia is dense and well developed in limbs. In the upper limb the deep fascia is tightly adherent to the underlying muscles especially in the forearm, thereby, restricting the space available to muscular swelling causing painful compartment syndrome. Division of this inelastic fascia or fasciotomy is an emergency procedure to decrease the morbidity and mortality.Methods: 30 patients with acute compartment syndrome of the upper extremity of various aetiologies were studied. Adults with painful, swollen and tense upper extremities with progressive neurological dysfunction were studied. Compartment pressures before and after fasciotomy were measured by a standard Whiteside’s device. Various fasciotomies were carried out and associated skeletal and vascular injuries were also noted.Results: The majority of patients were males with average age being 29.33 years. 56.67% patients with upper limb compartment syndrome sustained road traffic injury, 20% were constrictive tight cast, 20% of patients sustained burn and 1 patient was shot by bullet. Of the 30 patients fractures of both ulna and radius (40%) were the most common. Fractures of the humerus, radius, ulna and small bone of metacarpals together account for 36.67% of the affected patients. 3 patients were found to have injury to major vessels. Compartment pressure was measured by Whiteside’s device and fasciotomy resulted in a drastic drop of the pressure from pre-fasciotomy pressure of 44.8±7.9 mmHg to post-fasciotomy pressure of 12.33±3.61 mmHg.Conclusions: The diagnosis of compartment syndrome should be confirmed swiftly and prompt fasciotomy is the treatment of choice. This offers the best chance at decreasing compartment pressure and preventing further damage.