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Shiozakr Y.,Okayama University of Science | Ito Y.,Red Cross | Sugimoto Y.,Red Cross | Tomioka M.,Hyogo Emergency Medical Center | And 5 more authors.
Acta Medica Okayama | Year: 2012

In this study, we studied the relationship between fracture patterns and motor function recovery in 70 consecutive patients with cervical spinal cord injury. Fractures were categorized into 6 fracture types and subdivided into stages according to the Allen-Ferguson classification system: compressive flexion (CF), distractive flexion (DF), compressive extension (CE), distractive extension (DE), vertical com-pression (VC) and lateral flexion (LF). Paralysis was evaluated using theAmerican Spinal Injury Association (ASIA) impairment scale at the time of injury and 3 months afterwards. The residual rate of complete motor palsy (ASIA grade A or B) at the final examination was higher in those patients with DE fractures thanthose with CF, DF or CE. The final outcomes were as follows. Of the 14 patients who were classified with CF fractures, residual palsy was frequently seen in patients who had stage 5 injury. Of the 27 patients with DF fractures, residual palsy occurred in about half of the patients who had stage 4 or 5 injury. Of the 18 patients with CE fractures, residual palsy occurred in half of the patients with stage 3 injury or higher. Finally, of the 7 patients with DE fractures, the rate of residual palsy was high even for the stage 1 and 2 cases; indeed, all DE patients who had complete motor palsy at the first examination had residual palsy at the final examination. Accordingly, we conclude that motor recovery may be related to fracture pattern. © 2012 by Okayama University Medical School. Source


Sugimoto Y.,Red Cross | Ito Y.,Red Cross | Tomioka M.,Hyogo Emergency Medical Center | Shimokawa T.,Red Cross | And 3 more authors.
Acta Medica Okayama | Year: 2010

We used a navigation system to insert 128 pedicle screws into 69 vertebrae (LI to L3) of 49 consecutive patients. We assessed the pedicle isthmic width and the permission angle for pedicle screw insertion. The permission angle is the angle defined by the greatest medial and lateral trajectories allowable when placing the screw through the center of the pedicle. The rate of narrow-width pedicles (isthmic width less than 5mm) was 5 of 60 pedicles (8%) at LI, 4 of 60 pedicles (7%) at L2, and none (0%) at L3, L4 and L5. The rate of narrow-angle pedicles (a permission angle less than 15 degrees) was 21 of 60 pedicles (35%) at LI, 7 of 60 (12%) at L2, 3 of 60 (5%) at L3, and none (0%) at L4 and L5. Of 128 pedicle screws inserted into 69 vertebrae from LI to L3, 125 (97.7%) were classified as Grade 1 (no pedicle perforation). In general, the upper lumbar vertebrae have more narrow-width and -angle pedicles. However, we could reduce the rate of pedicle screw misplacement in upper lumbar vertebra using a three-dimensional fluoroscopy and navigation system. © 2010 by Okayama University Medical School. Source


Anan H.,Emergency Medical Center | Akasaka O.,Emergency Medical Center | Kondo H.,Medical Center | Nakayama S.,Hyogo Emergency Medical Center | And 4 more authors.
Disaster Medicine and Public Health Preparedness | Year: 2014

Objective: The objective of this study was to draft a new Japanese Disaster Medical Assistance Team (DMAT) training program based on the responses to the Great East Japan Earthquake.Methods: Working group members of the Japan DMAT Investigative Commission, Ministry of Health, Labour and Welfare, reviewed reports and academic papers on DMAT activities after the disaster and identified items in the current Japanese DMAT training program that should be changed. A new program was proposed that incorporates these changes.Results: New topics that were identified to be added to the DMAT training program were hospital evacuation, preparations to receive DMATs at damaged hospitals, coordination when DMAT activities are prolonged, and safety management and communication when on board small helicopters. The use of wide-area transport was reviewed and changes were made to cover selection of various transport means including helicopter ambulances. Content related to confined space medicine was removed. The time spent on emergency medical information system (EMIS) practical training was increased. Redundant or similar content was combined and reorganized, and a revised DMAT training program that did not increase the overall training time was designed.Conclusion: The revised DMAT training program will provide practical training better suited to the present circumstances in Japan. Copyright © Society for Disaster Medicine and Public Health, Inc. 2014. Source


Sugimoto Y.,Red Cross | Ito Y.,Red Cross | Tomioka M.,Hyogo Emergency Medical Center | Shimokawa T.,Red Cross | And 3 more authors.
Acta Medica Okayama | Year: 2010

Correct screw placement is especially difficult in the upper thoracic vertebrae. At the cervicothoracic junction (C7-T2), problems can arise because of the narrowness of the pedicle and the difficulty of using a lateral image intensifler there. Other upper thoracic vertebrae (T3-6) pose a problem for screw insertion also because of the narrower pedicle. We inserted 154 pedicle screws into 78 vertebrae (C7 to T6) in 38 patients. Screws were placed using intraoperative data acquisition by an isocentric C-arm fluoroscope (Siremobile Iso-C3D) and computer navigation. Out of 90 pedicle screws inserted into 45 vertebrae between C7 and T2, 87 of the 90 (96.7%) screws were classified as grade 1 (no perforation). Of 64 pedicle screws inserted into 33 vertebrae between T3 and T6, 61 of 64 (95.3%) screws were classified as grade 1. In this study, we reduced pedicle screw misplacement at the level of the C7 and upper thoracic (Tl-6) vertebrae using the three-dimensional fluoroscopy navigation system. © 2010 by Okayama University Medical School. Source


Anan H.,Emergency Medical Center | Akasaka O.,Emergency Medical Center | Kondo H.,National Hospital Organization Disaster Medical Center | Nakayama S.,Hyogo Emergency Medical Center | And 4 more authors.
Disaster Medicine and Public Health Preparedness | Year: 2014

Objective The objective of this study was to draft a new Japanese Disaster Medical Assistance Team (DMAT) training program based on the responses to the Great East Japan Earthquake. Methods Working group members of the Japan DMAT Investigative Commission, Ministry of Health, Labour and Welfare, reviewed reports and academic papers on DMAT activities after the disaster and identified items in the current Japanese DMAT training program that should be changed. A new program was proposed that incorporates these changes. Results New topics that were identified to be added to the DMAT training program were hospital evacuation, preparations to receive DMATs at damaged hospitals, coordination when DMAT activities are prolonged, and safety management and communication when on board small helicopters. The use of wide-area transport was reviewed and changes were made to cover selection of various transport means including helicopter ambulances. Content related to confined space medicine was removed. The time spent on emergency medical information system (EMIS) practical training was increased. Redundant or similar content was combined and reorganized, and a revised DMAT training program that did not increase the overall training time was designed. Conclusion The revised DMAT training program will provide practical training better suited to the present circumstances in Japan. (Disaster Med Public Health Preparedness. © 2014 Society for Disaster Medicine and Public Health, Inc. Source

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