• Journal of Chest Surgery
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• v.57 no.2
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• pp.120-125
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• 2024

Background: This study aimed to assess the outcomes of patients with complex rib fractures undergoing operative or nonoperative management at our major trauma center. Methods: A retrospective review of all patients who were considered for surgical stabilization of rib fractures (SSRF) at a single major trauma center from May 2016 to September 2022 was performed. Results: In total, 352 patients with complex rib fractures were identified. Thirty-seven patients (11%) fulfilled the criteria for surgical management and underwent SSRF. The SSRF group had a significantly higher proportion of patients with flail chest (32 [86%] vs. 94 [27%], p<0.001) or Injury Severity Score (ISS) >15 (37 [100%] vs. 129 [41%], p<0.001). No significant differences were seen between groups for 1-year mortality. Patients who underwent SSRF within 72 hours were 6 times less likely to develop pneumonia than those in whom SSRF was delayed for over 72 hours (2 [18%] vs. 15 [58%]; odds ratio, 0.163; 95% confidence interval, 0.029-0.909; p=0.036). Prompt SSRF showed non-significant associations with shorter intensive care unit length of stay (6 days vs. 10 days, p=0.140) and duration of mechanical ventilation (5 days vs. 8 days, p=0.177). SSRF was associated with a longer hospital length of stay compared to nonoperative patients with flail chest and/or ISS >15 (19 days vs. 13 days, p=0.012), whilst SSRF within 72 hours was not. Conclusion: Surgical fixation of complex rib fractures improves outcomes in selected patient groups. Delayed surgical fixation was associated with increased rates of pneumonia and a longer hospital length of stay.

• Tuberculosis and Respiratory Diseases
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• v.55 no.2
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• pp.188-197
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• 2003

Background : Smoke inhalation injury is an important determinant of mortality in burn patients. The early detection of inhalation injury in burn patients is important because the incidence of respiratory failure after inhalation injury was known to be high, with hypoxemia, pneumonia, and prolonged ventilatory support being commonplace. Acute carbon monoxide poisoning was one feature of smoke inhalation. The purpose of our study were to investigate the clinical characteristics of burn patients whose initial arterial carboxyhemoglobin (COHb) level had been elevated, to assess the clinical impact of COHb for smoke inhalation injury. Methods : Among 1,416 burn patients had been admitted at our institution from August 1, 2001 to July 31, 2002, 39 patients whose initial arterial COHb level have been more than 5% were included. We compared clinical scoring system for inhalation injury, percent total body surface area (%TBSA) burn, initial chest X-ray findings, APACHE II scores and SAPS II scores between survivors (n=27) and non-survivors (n=12) retrospectively. Results : COHb level were 9.7(5.71% and 10.3(8.81% in survivors and in non-survivors (p>0.05). Mean %TBSA burn of survivors and non-survivors were $16.6{\pm}17.8%$ and $60.7{\pm}28.8%$ (p<0.001). We did not find any difference in clinical scoring system, initial chest X-ray findings in survivors and in non-survivors. But %TBSA burn, APACHE II and SAPS II scores were high in non-survivors than in survivors significantly. Important factors associated with death were %TBSA burn, APACHE II scores, SAPS II scores, and the most important factor in predicting mortality was %TBSA burn. Conclusion : Burn patients with elevated initial arterial COHb level showed poor prognosis, but further study may be performed to know that the effect of COHb on prognosis in burn patients accompanying smoke inhalation.

• Tuberculosis and Respiratory Diseases
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• v.51 no.6
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• pp.503-516
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• 2001

Background : The present study was carried out in association with neutrophilic respiratory burst in the lung in order to clarify the pathogenesis of acute respiratory distress syndrome(ARDS) following acute severe hemorrhage. Because oxidative stress has been suggested as one of the principal factors causing tissue injury, the role of free radicals from neutrophils was assessed in acute hemorrhage-induced lung injury. Method : In Sprague-Dawley rats, hemorrhagic shock was induced by withdrawing blood(20 ml/kg of B.W) for 5 min and the hypotensive state was sustained for 60 min. To determine the mechanism and role of oxidative stress associated with phospholipase A2(PLA2) by neutrophils, the level of lung leakage, pulmonary myeloperoxidase(MPO), and the pulmonary PLA2 were measured. In addition, the production of free radicals was assessed in isolated neutrophils by cytochemical electron microscopy in the lung. Results : In hypotensive shock-induced acute lung injury, the pulmonary MPO, the level of lung leakage and the production of free radicals were higher. The inhibition of PLA2 with mepacrine decreased the pulmonary MPO, level of lung leakage and the production of free radicals from neutrophils. Conclusion : A. neutrophilic respiratory burst is responsible for the oxidative stress causing acute lung injury followed by acute, severe hemorrhage. PLA2 activation is the principal cause of this oxidative stress.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.63-67
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• 2010

Purpose: A tension pneumothorax is a fatal condition that requires immediate intervention. Although a definitive treatment for a tension pneumothorax is a tube thoracostomy, needle decompression can provide temporary relief, that is lifesaving. The traditional procedure for needle decompression involves inserting a needle or catheter at the second intercostal space, the midclavicular line. Recent evidence suggests that the commonly used catheters do not have sufficiently penetrate the chest wall. There are also claims that a lateral approach to needle decompression is easier and safer than the traditional anterior approach. The purpose of this study is to evaluate the optimal approach for needle decompression for the Korean population by measuring chest wall thicknesses at the points used for both the anterior and the lateral approaches. Methods: The chest wall thickness (CWT) of trauma victims who visited the Emergency Center of Pusan National University Hospital was measured by computed tomography (CT) images. The CWT was measured at the points used for the anterior and the lateral methods and was compared with the length of commonly used catheters, which is 45 mm. Results: The mean CWT at the second intercostal space, the midclavicular line, was shorter than the CWT at the 5th intercostal space, the anterior axillary line. However, the percentage of patients whose CWT was greater than 45 mm was larger when measured anteriorly (8.2%) that when measure laterally (5.7%). Female patients and those older than 60 were more likely to have an anterior CWT greater than 45 mm (28.2% for females and 15.5% for those older than 60). Conclusion: The percentage of trauma victims in Korea whose CWT is greater than 45 mm is lower than the values previously reported by other countries. However, females and older patients tend to have thicker chest walls, so the lateral approach would be suggested when performing needle decompression for such patients with suspected tension pneumothoraces.

• Transactions of the Korean Society of Automotive Engineers
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• v.12 no.2
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• pp.131-138
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• 2004

In the proto design stage of a new car, the performances of an occupant protection system can be evaluated by CAE even though the real test should be carried out. The number of the real test is reduced by the exact predictions followed by the appropriate design recommendation. However, the existing researches using CAE in predicting the performances do not consider the uncertainties of parameters. That often leads to inconsistency between test and CAE. In this research, the robust design of a protection system such as airbag and load limiter is suggested considering the frontal crash. The parameter design scheme of the Taguchi method is introduced to obtain the robust design of arbitrary airbag and load limiter. It is performed based on the frontal crash test condition of US-NCAP with an arbitrary passenger car. The variances of the performances such as HIC, chest acceleration and probability of combined injury are calculated by the outer array and the Taylor series expansion. Through the analysis of the Taguchi method, the robust optimum is determined.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.301-305
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• 1980

Myasthenia gravis is a disorder that affects neuromuscular transmission in a way that is still poorly understood. some think that myasthenia gravis results from a reduction of available acetylcholine receptors in neuromuscular junctions, consequent to some form of autoimmune injury. Surgical interest in this disease was first aroused in 1939 when Blalock observed that some patients with thymic tumors and myasthenia gravis improved following thymectomy. This report represents two cases of myasthenia gravis. The 14-year-old girl was admitted to Korea Universtiy Hospital with chief complaintment of bilateral ptosis, diplopia, swallowing difficulty, and mastication difficulty, which were relieved by administration of edrophonium (Tensilon) chloride, given intravenously. Myasthenica gravis was confirmed and thymectomy was given. After thymectomy, symptoms were relieved but the administration of neostigmine was contijued to be needed till following 3 months. After that period, she was free from this symptoms without anticholinesterase drugs. Second case is 57 year old male who has the symptoms of diplopia, bilatreal ptosis, walking disturbance, and speech difficulty. He had thymectomy too but in thymic tissue, malignant thymoma was included. He has subjective improvement only, with no major reduction of medication requirements after thymectomy.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.269-273
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• 1980

The rupture of the aorta commonly follows major blunt trauma to the thorax. It has markedly increased in recent years, paralleling the rising number of vehicular accidents. The most frequent site of rupture is the area of the isthmus, with the ascending aorta second. The diagnosis of the condition from clinical data is difficult, and aortography is used whenever aortic tear is suspected. We are presenting a case of patient who had intimal tearing of the thoracic aorta with multiple injuries. The patient underwent surgical repair 28 days after injury with left heart [LA-Femoral artery] bypass.

• Journal of Chest Surgery
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• v.37 no.12
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• pp.1022-1024
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• 2004

Pulmonary aspergillosis is the most common disease of fungal infection and has lower infectivity. Pulmonary asergillosis is classified by aspergilloma, bronchopulmonary aspergillosis, necrotic and invasive aspergillosis. Invasive aspergillosis is found in immune compromised host, immunosuppressive treatment after organ transplantation, anticancerous chemotherapy, blood abnormality, AIDS patients etc. We reported a case of invasive aspergillosis in an immunocompetent host, with review of literatures.

• Journal of Chest Surgery
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• v.47 no.2
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• pp.181-184
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• 2014

Here, we report a case of massive rhabdomyolysis following an uncomplicated repair of a ventricular septal defect in a five-month-old baby. Postoperatively, the patient was hemodynamically stable but metabolic acidosis continued, accompanied by fever and delayed mental recovery. The next day, he became comatose and never regained consciousness thereafter. The computed tomography of the brain revealed a diffuse brain injury. The patient followed a downhill course and eventually died on postoperative day 33. An unusually high level of creatine phosphokinase was noticed, peaking (21,880 IU/L) on postoperative day 2, suggesting severe rhabdomyolysis. The relevant literature was reviewed, and the possibility of malignant hyperthermia obscured by cardiopulmonary bypass and hypothermia was addressed.

• Annals of Clinical Neurophysiology
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• v.12 no.2
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• pp.66-69
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• 2010

A 73-year-old man with progressive quadriparesis was diagnosed as Guillain-Barr$\acute{e}$ syndrome. On the 6th hospital day, the patient complained of sudden chest discomfort. The blood test and echocardiography suggested myocardial injury, and acute myocardial infarction was considered. However, coronary angiography displayed no vascular lesion, and the electrocardiography and echocardiogram showed marked improvement 14 days later. We concluded the patient had a reversible cardiomyopathy which is a rare complication of Guillain-Barr$\acute{e}$ syndrome.