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The Mangled Extremity Severity Score (MESS) may be used to decide whether to perform amputation in patients with injuries involving a limb. A score of 7 points or higher indicates the need for amputation. We have treated three patients with a MESS of 7 points or higher, in two of which the injured limb was salvaged. This scoring system was originally devised to assess injuries to the lower limb. However, a MESS of 7 points as a justification for amputation does not appear appropriate when assessing injuries to the major vessels in the upper limb.

The efficacy of long-term drug therapy for patients with hypertrophic obstructive cardiomyopathy (HOCM) remains unclear. This study was performed to characterize the echocardiographic findings of patients responsive to drug therapy.Left ventricular outflow tract (LVOT) gradient and morphologic characteristics of the septum, posterior wall, and mitral valve were measured echocardiographically in 35 Japanese patients. The mean follow-up time was 41+/-22 months.Long-term drug therapy was effective in 14 patients and ineffective in 21 patients. Five of the refractory patients required mitral valve replacement to become free of symptoms. Only 5 of 21 patients whose LVOT gradient was 100 mm Hg were responsive to drug therapy, whereas 9 of 14 patients whose LVOT gradient was100 mm Hg were responsive to drug therapy. Seven of eight patients with an asymmetric septal hypertrophy (ASH) ratio==1.3 and LVOT gradient100 mm Hg were responsive to drug therapy. Only 3 of 16 patients with an ASH ratio1.3 were responsive to drug therapy. There was no correlation between the efficacy of drug therapy and the morphology of the mitral valve or the width of the LVOT.Our results demonstrate that drug therapy effectively reduces the LVOT gradient in patients with asymmetric septal hypertrophy and a less severe LVOT gradient.

The purpose of the study was to evaluate the influence of hyperoxia and hypercapnia on respiration and metabolism during a steady-state exercise. Thirteen healthy subjects were examined during bicycle-ergometer rides at approximately 50% VO2max under four different breathing gas conditions: 1) room air (control); 2) 40% oxygen; 3) 3% carbon dioxide; 4) 40% oxygen and 3% carbon dioxide. Hyperoxia, with or without hypercapnia, decreased respiratory ventilation and carbon dioxide elimination significantly. On the other hand, oxygen uptake in hyperoxia was not significantly different from that of normoxia. Hypercapnia increased respiratory ventilation more than 30% compared to normocapnia, but it did not change oxygen uptake and carbon dioxide elimination significantly.

Functional differentiation is found in the spinal cord. A unique set of neurological deficits follows a multi-focal injury. Clinically, sensory and motor disturbance present independently, often resulting in sensory and motor deficit dissociation. This study examined 103 spinal decompression illness (DCI) cases. The neurological deficit dissociation was classified as follows: 1) Cases with sensory impairment only, or motor dysfunction alone, were tagged as having "dissociation" (44 cases); when a case was with both sensory and motor dysfunction, the spinal level of the sensory impairment was determined and was matched with the spinal segments responsible for the motor dysfunction; 2) If the two spinal areas did not match (i.e. with no regional overlap), they were tagged as having "dissociation" for each motor dysfunction (32 cases). In total, dissociation was present in 76 out of 103 cases. We concluded that clinical neurological deficit dissociation is frequently observed in spinal DCI.

Objectives: The aim of this study is to clear the status of recreational scuba divers in Japan for promoting safety in recreational diving. Methods: A five year (from 1996 to 2001) questionnaire survey was performed of Japanese divers at the Osezaki area in Japan. The subjects of this survey included diving instructors as well as recreational divers. Based on the obtained data, the study investigated the theory predicted incidence of decompression sickness (DCS) among Japanese recreational divers. Results: The average (SD) of the maximum depth for diving was 37.4 (13.1) metres, which was deeper than the recommended depth of recreational diving. The incident rate of nitrogen narcosis (12%) was the most frequent, followed by barotraumas of the ear (11%) and barotraumas of the paranasal sinus (5.6%). The rate of DCS was 1.9 % (60 divers) during investigated period, and that DCS occurred once per 19 011 dives in calculation. Conclusions: This investigation showed that the status of leisure diving in Japan is still serious, because DCS would be expected to occur once a weekend in Japan. It is speculated that many divers may develop DCS while moving through high altitudes after diving, particularly at the Osezaki diving spot in Japan. Based on the results of this study, it is emphasised that every Japanese leisure diver should take an increasing interest in the safety of diving activity.

The purpose of this study was to evaluate the safety of Self-Contained-Self-Rescuers (SCSRs) under a heavy work load. Three units, two chemical-oxygen (KO2) types and one compressed-oxygen type, were evaluated by a breathing and metabolic simulator and by a human subject. The metabolic rate in the simulator tests was equivalent to light work; the human subject tests were at a heavy work load. With regard to the main physiological stressors imposed by SCSRs, it was found that the inhalation temperature under heavy work conditions was able to be estimated from the data of the light work condition; the breathing resistance had roughly the same relationship under both light and heavy work conditions. On the other hand, for the inhaled carbon dioxide, there was no correlation between the two conditions. It was found that some SCSRs experienced a rapid increase in inhaled carbon dioxide when the metabolic rate of the user exceeded the absorbent capacity of the units. In those cases, the user could not continue walking nor breathing through the unit. To ensure the safety of the user, we propose that the certification standards be changed to include evaluation of carbon dioxide absorbent capacity under heavy work load.