Physeal Distal Radial Fracture with Entrapment of the Tendons of Extensor Pollicis Longus and Extensor Digitorum Communis to Index Finger.

We report the entrapment of the extensor tendons following a growth plate fracture of the distal radius in a teenager. It is difficult to detect tendon entrapment at the fracture site immediately after the injury and diagnosis is typically made after fracture union when patients present with an inability to extend the thumb/reduced digital movement. A careful examination of our patient demonstrated some loss of digital motion and the plain radiographs, and computed tomographic scan showed incomplete reduction suggesting tendon entrapment. Early detection of the entrapped tendons allowed prompt release averting the need for tendon reconstruction. This report highlights the need for clinicians to maintain a high index of suspicion for tendon entrapment in patients with distal radius fractures that present with limited digital motion associated with incomplete reduction. An early diagnosis followed by the timely release can result in excellent outcomes. Level of Evidence: Level V (Therapeutic).

Feasibility of pre- and postoperative arthroscopic assessments with internal fixation for growth plate injury of the distal tibia: three case reports and a literature review.

BACKGROUND: Inappropriate treatment of growth plate injury may cause complications such as malunion or early arrest of the growth plate. Identification of intra-articular lesions is mandatory in patients with a growth plate injury of the distal tibia. Arthroscopic assessment is useful in identifying intra-articular injury. We report three cases of intra-articular growth plate injury of the distal tibia that were treated via internal fixation with arthroscopic assessment in our hospital. MATERIALS AND METHODS: All three cases were performed pre- and postoperative arthroscopic assessment and open reduction and internal fixation with a cannulated cancellous screw (CCS; Meira, Japan). All patients were then examined for postoperative complications, functional recovery, at the end of the final follow-up consultation. RESULTS: Intraoperatively, a small cartilage injury was found in the non-fracture area in two cases; the remaining case had a reversed cartilage fragment at the talus, which was arthroscopically removed. CONCLUSIONS: Arthroscopic assessment followed by internal fixation is a useful minimally invasive method for the identification of intra-articular lesions such as osteochondral injury or free bodies.

Patellar Tendon Avulsion with Tibial Tuberosity Sleeve Fragment.

Rupture of the patellar tendon is relatively rare. We report a case of patellar tendon avulsion with a tibial tuberosity sleeve fragment in pediatric patient. In pediatric patient, diagnosis is sometimes difficult due to uncompleted ossification. In the present case, which involved the presence of a small fleck of bone from tibia, we were able to attain a diagnosis using the Koshino-Sugimoto index and MRI and easily determine the optimal treatment with the use of the suture anchor and tension band wiring method.

A case of suspected brain death within 24 hours after ingestion of tolfenpyrad and an organophosphorus insecticide.

A 55-year-old man attempted suicide by ingesting tolfenpyrad, emulsion formulation insecticide, and organophosphorus pesticide emulsion, each three gulps. He was found lying on the floor and his family called an ambulance an hour later from ingesting. On arrival at our hospital, his Glasgow Coma Scale score was 14 (E3V5M6), his vital signs were stable, and he was able to converse. Activated charcoal and laxatives were injected through a gastric tube, and continuous administration of pralidoxime iodide was started. After hospitalization, he complained of nausea and his consciousness level decreased immediately. Endotracheal intubation was performed, and mechanical ventilation management was started Subsequently, he experienced bradycardia leading to transient cardiopulmonary arrest. Return of spontaneous circulation was achieved after one cycle of cardiopulmonary resuscitation. While blood pressure was stabilized with continuous catecholamine administration, blood gas analysis revealed severe lactic acidosis, which gradually aggravated. Electroencephalography performed 16.5 hours after the suicide attempt showed flat waves, and he wa's suspected brain dead. He died about 37 hours after the suicide attempt.

Directional bleb formation in spherical cells under temperature gradient.

Living cells sense absolute temperature and temporal changes in temperature using biological thermosensors such as ion channels. Here, we reveal, to our knowledge, a novel mechanism of sensing spatial temperature gradients within single cells. Spherical mitotic cells form directional membrane extensions (polar blebs) under sharp temperature gradients (≥∼0.065°C µm(-1); 1.3°C temperature difference within a cell), which are created by local heating with a focused 1455-nm laser beam under an optical microscope. On the other hand, multiple nondirectional blebs are formed under gradual temperature gradients or uniform heating. During heating, the distribution of actomyosin complexes becomes inhomogeneous due to a break in the symmetry of its contractile force, highlighting the role of the actomyosin complex as a sensor of local temperature gradients.

Transabdominal ultrasound-guided urethral catheterization with transrectal pressure.

BACKGROUND: Occasionally, difficulty with standard urethral catheterization is encountered. OBJECTIVE: We conducted a pilot study to evaluate whether transabdominal ultrasound (TAUS) showed the tip of a urethral catheter and whether TAUS-guided catheterization with transrectal pressure is successful in male patients in whom performing standard catheterization is difficult. METHODS: The eligible study participants included adult male patients in whom standard catheterization failed in our emergency department or who were transferred from other facilities after failure of catheterization and subsequent urethral bleeding. The enrolled patients included those in whom the tip of a catheter could not be advanced through the posterior and bulbar urethra judging from the inserted length. First, an emergency nurse advanced a catheter until the progress was obstructed. Next, an emergency physician performed TAUS to detect the tip of the catheter. If the tip was detected, the physician inserted the index finger into the rectum and kept pushing the site of the obstruction. After following these procedures, the nurse again advanced the catheter. RESULTS: Six patients were enrolled. The tip of a catheter was detected in the urethra or the false passage using TAUS in 4 of the 6 patients. In these 4 patients, the curve of the urethra became gentle or the false passage was compressed by transrectal pressure and the tip was advanced smoothly to the bladder. CONCLUSIONS: In some male patients in whom performing standard urethral catheterization is difficult, TAUS reveals the tip of the catheter and TAUS-guided catheterization with transrectal pressure can be safe and useful.