RESUMEN
We report a case of crush syndrome that developed while the patient was squatting to use a Japanese-style toilet. The patient was a 61-year-old male with an obese body. He was sitting on the toilet and couldn't stand up, and after a few hours, the landlord found him and called the emergency services. On presentation, the patient was hyperkalemic and in shock, and his serum creatine kinase levels rose to a maximum of 287,600 U/L. He was diagnosed with postural crush syndrome in both lower extremities due to squatting position in a Japanese-style toilet. Subjective symptoms, physical examination, and blood tests were monitored and the patient was observed. As a result, the patient could be treated conservatively without fasciotomy. Dialysis was not necessary because the fluid infusion maintained adequate urine output and corrected the hyperkalemia. Magnetic resonance imaging of both lower extremities showed multiple high-signal areas in the muscles of the bilateral thighs and lower legs. This case suggested that if the wound is closed, the peripheral pulse is palpable, and the patient's symptoms have improved, a fasciotomy should not be performed. People who are too heavy to squat may need to be careful when using this kind of toilet.
RESUMEN
This is a critical comment on the paper by Endo et al. on the volume-outcome relationship on survival and cost benefits in severe burn injury which addresses biases related to patient transfer and burn severity assessment.
RESUMEN
BACKGROUND: The association between social relationships and lower mortality has been well documented in Western countries. This study aims to investigate that association among elderly Japanese in a rural area. METHODS: An analysis was conducted with 1,994 subjects (58.1% women), 78.3% of the total elderly aged 65 and older in a town, who were independent in activities of daily living. A baseline survey was carried out in 1992, and subjects were followed until 1999. Cox proportional hazard models examined the association between social relationships (availability of casual friend/ support provider, group membership, job, living arrangement) and an 88-month mortality. RESULTS: A significant association between social relationships and mortality was observed among the old-old (aged 75 and older). Among men, having a job and group membership were significantly associated with lower mortality with hazard ratios (95% confidence intervals) of 0.62 (0.41-0.94) and 0.60 (0.40-0.90), respectively, after adjustment for age, diagnosed illnesses, self-rated health, other social relationships, annual income, and home ownership. Among women, having a job and living alone were significantly associated with lower mortality with hazard ratios (95% confidence intervals) of 0.67 (0.45-0.99) and 0.35 (0.13-0.97), respectively. CONCLUSIONS: Social relationships such as having a job and group membership were associated with lower mortality among the old-old. In addition, old-old women living alone were better off in terms of mortality after adjustment for possible confounders. This suggests the importance of considering family relationships in terms of quality in areas where multi-generation households prevail.
