Fracturing and Episodic Fluid Expulsion in Pressure Compartments

The fracturing of the pressure compartments in sedimentary basins may not be caused completely by natural hydraulic fracturing. On the bases of fracture mechanics and numerical simulation, we consider that there are two mechanisms concerning the fracturing of pressure compartments, which are as follows: (1) natural hydraulic fracturing of the sediments within pressure compartments, and (2) tensile fracturing due to tangential traction. When the fracture, formed in the sediments within pressure compartments due to hydraulic fracturing, arrives at the base of the seal, the intensely tangential tensile stresses are created and lead to the fracturing of the seal. After the seal fractured, the fluid escaped from the pressure compartments. In a shallow pressure compartment, the duration of fracture opening and fluid expulsion is about 10-20 years in a cycle.

Functional outcome of tibial fracture with acute compartment syndrome and correlation to deep posterior compartment pressure

AIM To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome(ACS) and to correlate it with functional outcome.METHODS Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale(LEFS)] and complications were assessed.RESULTS Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk(10 to 54 wk) and 23.8 ± 9.2 wk(12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness(76%) that caused difficulty in walking,running and squatting. Of 21 patients who had paralysis at diagnosis, 13(62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients(48.3%) with severe disability, 10 patients(34.5%) with moderate disability and 5 patients(17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmH g respectively(P < 0.001).CONCLUSION ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intracompartmental pressure(ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.

Study of the Constituent of Abnormal Low Pressure Compartment and Fluid Characteristics in Huatugou Oilfield,Qaidam Basin

Based on the comprehensive research on core samples,well testing data and fluid parameters of the reservoirs,the depositional architecture of the abnormal low pressure compartment and fluid characteristics of Huatugou oilfield of Qaidam basin were reported,and the correlation between the compartment and hydrocarbon accumulation was revealed. The result indicates that the reservoirs are located

Airway Pressure Release Ventilation Improves Oxygenation in a Patient with Pulmonary Hypertension and Abdominal Compartment Syndrome

The following case describes the favorable application of airway pressure release ventilation (APRV) in a patient with pulmonary hypertension who developed respiratory failure and abdominal compartment syndrome after abdominal closure from an incarcerated umbilical hernia. A 66-year-old male with past medical history of restrictive lung disease, obstructive sleep apnea and pulmonary hypertension, presented to the operating room for an incarcerated inguinal hernia. After abdominal closure, he gradually developed decreased oxygen saturation and hypotension. APRV was initiated during post operative day 2 after inability to maintain adequate oxygen saturation with resultant hypotension on pressure control ventilation with varying degrees of positive end expiratory pressure and 100% inspired oxygen concentration. The initial set high pressure on APRV was 35 mm Hg. Yet, in lieu of decreasing lung compliance, it peaked at 50 mm Hg. Eventually, inhaled Nitric Oxide was initiated post operative day 3 due to increasing pulmonary arterial pressures. A bedside laparotomy was eventually performed when bladder pressures peaked to 25 mm Hg. APRV gradually and temporally improved the oxygen saturation and decreased the pulmonary arterial pressures with subsequent increase in systemic blood pressures. APRV promoted alveolar recruitment and decreased the shunting associated with abdominal compartment syndrome. Better oxygen saturations lead to increases in blood pressure by decreasing the effects of hypoxic pulmonary vasoconstriction on the right ventricle (RV). In patients with decreasing lung compliance and pulmonary comorbidities, APRV appears safe and allows for improve oxygenation, after failure with conventional modes of ventilation.

Surgical decompression for the management of abdominal compartment syndrome with severe acute pancreatitis: A narrative review

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)play a pivotal role in the pathophysiology of severe acute pancreatitis(SAP)and contribute to new-onset and persistent organ failure.The optimal management of ACS involves a multi-disciplinary approach,from its early recognition to measures aiming at an urgent reduction of intra-abdominal pressure(IAP).A targeted literature search from January 1,2000,to November 30,2022,revealed 20 studies and data was analyzed on the type and country of the study,patient demographics,IAP,type and timing of surgical procedure performed,post-operative wound management,and outcomes of patients with ACS.There was no randomized controlled trial published on the topic.Decom-pressive laparotomy is effective in rapidly reducing IAP(standardized mean difference=2.68,95%confidence interval:1.19-1.47,P<0.001;4 studies).The morbidity and complications of an open abdomen after decompressive laparotomy should be weighed against the inadequately treated but,potentially lethal ACS.Disease-specific patient selection and the role of less-invasive decompressive measures,like subcutaneous linea alba fasciotomy or component separation techniques,is lacking in the 2013 consensus management guidelines by the Abdominal Compartment Society on IAH and ACS.This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP.However,there is a lack of high-quality evidence on patient selection,timing,and modality of surgical decompression.Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS.

柴达木盆地西部油泉子油田超压形成机制

柴达木盆地西部油泉子油田新生界地层超压广泛发育,超压成因的判别对于油气运移、成藏等方面的研究具有重要意义。通过对油泉子油田的实测压力、测井曲线、声波速度-密度交会图、超压成因综合分析法和超压封存箱模式的综合分析,对研究区超压形成机制进行研究。结果表明:油泉子油田新生界地层纵向上发育负压、常压、超压和强超压系统,超压系统压力系数普遍大于1.3。部分超压点压力系数大于1.73,表现为强超压的特点;该区超压主控因素为不均衡压实、构造挤压作用和生烃作用,油气运移符合超压封存箱模式,由于超压的作用导致油气向南翼山地区运移。该研究成果明确了油泉子油田油气的运移方向,对柴西地区及相似区域油气的成藏研究工作具有指导意义。

密闭增压补氧舱泄压过程中的木垛燃烧特性研究

为探究增压补氧舱泄压时间对人员安全疏散的影响,通过增压补氧舱的泄压试验对舱体泄压时压力与时间的关系进行验证。对比模拟与真实泄压曲线,验证了泄压理论公式适用于增压补氧舱的泄压过程计算。模拟高海拔条件下增压补氧舱的泄压过程,结果表明:使用1个DN20、2个DN40和1个DN65规格的泄压阀可满足此类建筑安全疏散的要求。当密闭增压建筑中某房门未紧闭的标准舱室内发生4层木垛燃烧后,若能及时对建筑进行整体泄压,对标准舱外公共区域的人员疏散影响较小。研究成果可为高海拔密闭增压建筑的推广应用提供参考。

Should we perform decompressive laparotomy during severe acute pancreatitis with intra-abdominal hypertension below 25 mmHg:Only the gut knows

We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 mmHg.Indeed,in this setting,non-occlusive mesenteric ischemia(NOMI)may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly restored.We report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg.

医疗救护飞机飞行高度对吸痰效果影响的研究

目的研究医疗救护飞机飞行高度对机上吸痰效果的影响。方法通过低压舱分别模拟医疗救护飞机在距离地面0、1000、2350、3350 m和4300 m不同飞行高度的机舱内部气压环境,选择同一粘度的人工模拟痰液代替伤病员真实痰液作为试验样本,使用同一吸痰设备及相同操作步骤和手法开展伤病员吸痰实验,分别记录痰液吸净所用时间。结果在模拟医疗救护飞机在距离地面5个不同飞行高度下,5 ml模拟痰液吸净所需时间随模拟飞行高度的增加而逐步延长,1000、2350、3350 m和4300 m的吸痰用时分别是(5.09±0.30)、(9.37±1.00)、(11.75±0.78)s和(15.54±0.92)s,均高于0 m吸痰用时(4.26±1.13)s。方差分析结果显示,飞行高度1000 m吸痰用时与0 m的差异无统计学意义(P=0.27),飞行高度2350 m、3350 m、4300 m吸痰用时分别与0 m的差异均具有统计学意义(P均<0.001)。两两比较结果显示2350 m与1000 m(P<0.001)、3350 m与2350 m(P<0.001)及4300 m与3350 m(P<0.001)高度下吸痰时间的差异均具有统计学意义。结论医疗救护飞机飞行高度上升,会增加吸痰用时,导致吸痰效率降低,增加伤病员窒息风险。随着飞行高度增加,需采取增加负压压力、湿化气道等有效措施以确保机上吸痰效果。

基于空气压力载荷的发动机舱盖颤振预测方法

发动机舱盖作为吸收汽车碰撞能量的主要部件,其在高速道路行驶条件下的变形和颤振问题是影响汽车安全的重要因素。基于发动机舱盖颤振性能要求,文章提出了一种高速行驶条件下发动机舱盖颤振变形的预测方法。通过有限元模拟计算,考虑重力作用下的准静态加载、缓冲垫和弹簧作用下的弹性力加载,以及高速行驶条件下空气压力载荷的多维加载工况,完成了方法定义、模型建立、性能分析、试验校核,研究了多维加载对发动机舱盖颤振的影响,验证了该预测方法开发和应用的可行性与有效性。

Abdominal compartment syndrome:Often overlooked conditions in medical intensive care units

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

Characteristics of Abnormal Pressure Systems and Their Responses of Fluid in Huatugou Oil Field,Qaidam Basin

Based on the comprehensive study of core samples, well testing data, and reservoir fluid properties, the construction and the distribution of the abnormal pressure systems of the Huatugou oil field in Qaidam Basin are discussed. The correlation between the pressure systems and hydrocarbon accumulation is addressed by analyzing the corresponding fluid characteristics. The results show that the Huatugou oil field as a whole has low formation pressure and low fluid energy; therefore, the hydrocarbons are hard to migrate, which facilitates the forming of primary reservoirs. The study reservoirs, located at the Xiayoushashan Formation （N1/2） and the Shangganchaigou Formation （N1） are relatively shallow and have medium porosity and low permeability. They are abnormal low-pressure reservoirs with an average formation pressure coefficient of 0.61 and 0.72 respectively. According to the pressure coefficient and geothermal anomaly, the N1 and N1/2 Formations belong to two independent temperature-pressure systems, and the former has slightly higher energy. The low-pressure compartments consist of a distal bar as the main body, prodelta mud as the top boundary, and shore and shallow lake mud or algal mound as the bottom boundary. They are vertically overlapped and horizontally paralleled. The formation water is abundant in the Cl^- ion and can be categorized as CaCl2 type with high safinity, which indicates that the abnormal low-pressure compartments are in good sealing condition and beneficial for oil and gas accumulation and preservation.

Elevated intra-abdominal pressure:A review of current knowledge

Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure.Raised IAP affects every system and main organ in the human body.Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery.Yet,despite being so common,this potentially lethal condition often goes unnoticed.In 2004,the World Society of the Abdominal Compartment Syndrome,an international multidisciplinary consensus group,was formed to provide unified definitions,improve understanding and promote research in this field.Simple,reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management.The correct,structured approach to treatment can have a striking effect and fully restore homeostasis.In recent years,significant progress has been made in this area with the contribution of surgeons,internal medicine specialists and anesthesiologists.Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis,monitoring and treatment of this life-threatening condition.

Abdominal compartment syndrome among surgical patients

Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compliance,and other factors that exert a constant pressure within the abdominal cavity.Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction.Among surgical and trauma patients,aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS.Other conditions that have also been identified as risk factors are ascites,hemoperitoneum,bowel distention,and large tumors.All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH).Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery,abdominal aortic aneurysm repair,and liver transplantation among others.Close monitoring of organ function and intra-abdominal pressure(IAP)allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP.Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction.There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.

Noninvasive monitoring of intra-abdominal pressure by measuring abdominal wall tension

BACKGROUND: Noninvasive monitoring of intra-abdominal pressure(IAP) by measuring abdominal wall tension(AWT) was effective and feasible in previous postmortem and animal studies. This study aimed to investigate the feasibility of the AWT method for noninvasively monitoring IAP in the intensive care unit(ICU).METHODS: In this prospective study, we observed patients with detained urethral catheters in the ICU of Shanghai Tenth People's Hospital between April 2011 and March 2013. The correlation between AWT and urinary bladder pressure(UBP) was analyzed by linear regression analysis. The effects of respiratory and body position on AWT were evaluated using the paired samples t test, whereas the effects of gender and body mass index(BMI) on baseline AWT(IAP<12 mm Hg) were assessed using one-way analysis of variance.RESULTS: A total of 51 patients were studied. A significant linear correlation was observed between AWT and UBP(R=0.986, P<0.01); the regression equation was Y=–1.369+9.57X(P<0.01). There were signif icant differences among the different respiratory phases and body positions(P<0.01). However, gender and BMI had no signif icant effects on baseline AWT(P=0.457 and 0.313, respectively).CONCLUSIONS: There was a signif icant linear correlation between AWT and UBP and respiratory phase, whereas body position had signif icant effects on AWT but gender and BMI did not. Therefore, AWT could serve as a simple, rapid, accurate, and important method to monitor IAP in critically ill patients.

Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

AIM: To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on physiological functions, and the association of the presence of IAH/ACS and outcome. METHODS: Patients (n = 74) with AP recruited in this study were divided into two groups according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter during the first week after admission. Patients (n = 44) with IAP ≥ 12 mmHg were assigned in IAH group, and the remaining patients (n = 30) with IAP < 12 mmHg in normal IAP group. For analysis of the influence of IAH/ACS on organ function and outcome, the physiological parameters and the occurrence of organ dysfunction during intensive care unit (ICU) stay were recorded, as were the incidences of pancreatic infection and in-hospital mortality. RESULTS: IAH within the first week after admission was found in 44 patients (59.46%). Although the APACHE Ⅱ scores on admission and the Ranson scores within 48 h after hospitalization were elevated in IAH patients in early stage, they did not show the statistically significant differences from patients with normal IAP within a week after admission (16.18 ± 3.90 vs 15.70 ± 4.25, P = 0.616; 3.70 ± 0.93 vs 3.47 ± 0.94, P = 0.285, respectively). ACS in early AP was recorded in 20 patients (27.03%). During any 24-h period ofthe first week after admission, the recorded mean IAP correlated significantly with the Marshall score calculated at the same time interval in IAH group (r = 0.635, P < 0.001). Although ACS patients had obvious amelioration in physiological variables within 24 h after decompression, the incidences of pancreatitic infection, septic shock, multiple organ dysfunction syndrome (MODS) and death in the patients with ACS were significantly higher than that in other patients without ACS (pancreatitic infection: 60.0% vs 7.4%, P < 0.001; septic shock: 70.0% vs 11.1%, P < 0.001; MODS: 90.0% vs 31.5%, P < 0.001; mortality: 75.0% vs 3.7%, P < 0.001). CONCLUSION: IAH/ACS is a frequent finding in patients admitted to the ICU because of AP. Patients with IAP at approximately 10-12 mmHg and early signs of changes in physiologic variables should be seriously considered for urgent decompression to improve survival.

Early recognition of abdominal compartment syndrome in patients with acute pancreatitis

AIM:To assess the value of widely used clinical scores in the early identification of acute pancreatitis(AP) patients who are likely to suffer from intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS). METHODS:Patients(n=44)with AP recruited in this study were divided into two groups(ACS and non-ACS) according to intra-abdominal pressure(IAP)determined by indirect measurement using the transvesical route via Foley bladder catheter.On admission and at regular intervals,the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems:Glasgow-Imrie score,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE-Ⅱ)score,and Multiorgan Dysfunction Score(MODS).The diagnostic performance of scores predicting ACS development,cut-off values and specificity and sensitivity were established using receiver operating characteristic(ROC)curve analysis. RESULTS:The incidence of ACS in our study population was 19.35%.IAP at admission in the ACS group was 22.0(18.5-25.0)mmHg and 9.25(3.0-12.4)mmHg in the non-ACS group(P<0.01).Univariate statistical analysis revealed that patients in the ACS group had significantly higher multifactorial clinical scores(APACHE Ⅱ,Glasgow-Imrie and MODS)on admission and highermaximal scores during hospitalization(P<0.01).ROC curve analysis revealed that APACHEⅡ,Glasgow-Imrie, and MODS are valuable tools for early prediction of ACS with high sensitivity and specificity,and that cut- off values are similar to those used for stratification of patients with severe acute pancreatitis(SAP). CONCLUSION:IAH and ACS are rare findings in patients with mild AP.Based on the results of our study we recommend measuring the IAP in cases when patients present with SAP(APACHEⅡ>7;MODS>2 or Glasgow-Imrie score>3).

Indwelling catheter and conservative measures in the treatment of abdominal compartment syndrome in fulminant acute pancreatitis

瞄准：学习联合留置导管，血过滤，呼吸支持和繁体中文药的效果(例如 Dahuang ) 在治疗暴发性的尖锐胰腺炎的腹的分隔空间症候群。方法：有暴发性的尖锐胰腺炎的病人随机被划分成监视的腹的排水和 intra 腹的压力和平淡的保守措施组(组 1 ) 和控制组织的 2 组联合留置导管(组 2 ) 。平淡的非起作用的保守疗法包括血过滤，呼吸支持，胃肠的 TCM 沐浴也在控制组病人被使用。二个组的有效性被观察，并且 APACHE II 分数被申请分析。结果：在第二和第五天术后疗法上，组 1 和 2 病人的 APACHE II 分数是显著地不同的。有效性的比较(腹痛和 burbulence 消除时间，住院时间) 在组之间， 1 和 2 显示出包囊的有效差量，以及发生率形成。组的死亡率 1 和 2 分别地是 10.0% 和 20.7% 。为在组 1 的病人，腹的排水数量和 intra 腹的压力，和住院时间断然被相关(r = 0.552， 0.748， 0.923， P【0.01 ) 与 APACHE， II 得分。结论：联合留置导管腹的排水和 intra 腹的压力监视的、短 veno 静脉的血过滤(SVVH ) ，胃肠的 TCM 沐浴，呼吸支持在暴发性的尖锐胰腺炎的腹的分隔空间症候群上有预防措施和治疗效果。

Lower limb intracast pressures generated by different types of immobilisation casts

AIM To determine if complete, split casts and backslabs [plaster of Paris(POP) and fiberglass] generate different intracast pressures and pain. METHODS Increased swelling within casts was modeled by a closed water system attached to an expandable bag placed directly under different types of casts applied to a healthy lower limb. Complete fiberglass and POP casts, split casts and backslabs were applied. Twenty-five milliliter aliquots of saline were injected into the system and the generated intracast pressures were measured using a sphygmomanometer. The subject was blinded to the pressure scores to avoid bias. All casts were applied to the same right limb on the same subject to avoid the effects of variations in anatomy or physiology on intracast pressures. Pain levels were evaluated using the Visual Analogue Score after each sequential saline injection. Each type of cast was reapplied four times and the measurements were repeated on four separate occasions. Sample sizes were determined by a pre-study 90% power calculation to detect a 20% difference in intracast pressures between cast groups. RESULTS A significant difference between the various types of casts was noted when the saline volume was greater than 100 mL(P = 0.009). The greatest intracast pressure was generated by complete fiberglass casts, which were significantly higher than complete POP casts or backslabs(P = 0.018 and P = 0.008 respectively) at intracast saline volumes of 100 mL and higher. Backslabs produced a significantly lower intracast pressure compared to complete POP only once the saline volume within casts exceeded 225 mL(P = 0.009). Intracast pressures were significantly lower in split casts(P = 0.003). Split POP and fiberglass casts produced the lowest intracast pressures, even compared to backslabs(P = 0.009). Complete fiberglass casts generated the highest pain levels at manometer pressures of 75 mm Hg and greater(P = 0.001). Split fiberglass casts had significantly reduced pain levels(P = 0.001). In contrast, a split complete POP cast did not produce significantly reduced pain levels at pressures between 25-150 mmH g. There was no difference in pain generated by complete POP and backslabs at manometer pressures of 200 mm Hg and lower. CONCLUSION Fibreglass casts generate significantly higher intracast pressures and pain than POP casts. Split casts cause lower intracast pressures regardless of material, than complete casts and backslabs.

Forearm Loss Caused by Automated Non-Invasive Blood Pressure Cuff Malfunction: A Hearsay Report

Failure of an automated blood pressure cuff to deflate when a patient is under general anesthesia can lead to catastrophic consequences if unnoticed for more than three hours [1]. We present this as a hearsay case in which an automated blood pressure cuff of the Spacelabs Ultraview Clinical Workstation monitor (model No. 90385) applied pressure for about five hours resulting in limb thrombosis. In order to analyze this catastrophe, simulation scenarios were tested to elucidate the possible errors and malfunctions that may have led to this injury. We present the analysis of the advantages and validity of the hearsay case report. We also include our proposed criteria that should be required when a hearsay case is considered for publication.