• Title/Summary/Keyword: Severe injury

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Protective Effect of Defibrotide on Splanchnic Injury following Ischemia and Reperfusion in Rats

  • Choi, Soo-Ran;Jeong, Ji-Hoon;Song, Jin-Ho;Shin, Yong-Kyoo
    • The Korean Journal of Physiology and Pharmacology
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    • v.10 no.2
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    • pp.85-94
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    • 2006
  • A splanchic artery occlusion for 90 min followed by reperfusion of the mesenteric circulation resulted in a severe form of circulatory shock, characterized by endothelial dysfunction, severe hypotension, marked intestinal tissue injury, and a high mortality rate. The effect of defibrotide, a complex of single-stranded polydeoxyribonucleotides having antithrombotic effect, was investigated in a model of splanchnic artery occlusion (SAO) shock in urethane anesthetized rats. Occlusion of the superior mesenteric artery for 90 min produced a severe shock state, resulting in a fatal outcome within 120 min of reperfusion in many rats. Defibrotide (10 mg/kg body weight) 10 min prior to reperfusion significantly improved mean arterial blood pressure in comparison to vehicle treated rats (p<0.05). Defibrotide treatment also significantly attenuated in the increase of plasma amino nitrogen concentration, intestinal myeloperoxidase activity, intestinal lipid peroxidation, infiltration of neutrophils in intestine and thrombin induced adherence of neutrophils to superior mesentric artery segments. Superoxide anion and hydrogen peroxide production in $1{\mu}M$ formylmethionylleucylphenylalanine (fMLP)-activated PMNs was inhibited by defibrotide in a dose-dependent fashion. Defibrotide effectively scavenged hydrogen peroxide, but not hydroxyl radical. Treatment of SAO rats with defibrotide inhibited tumor necrosis factor-${\alpha}$, and interleukin-1${\beta}$ productions in blood in comparison with untreated rats. These results suggest that defibrotide partly provides beneficial effects by preserving endothelial function, attenuating neutrophil accumulation, and antioxidant in the ischemic reperfused splanchnic circulation

Major Causes of Preventable Death in Trauma Patients

  • Park, Youngeun;Lee, Gil Jae;Lee, Min A;Choi, Kang Kook;Gwak, Jihun;Hyun, Sung Youl;Jeon, Yang Bin;Yoon, Yong-Cheol;Lee, Jungnam;Yu, Byungchul
    • Journal of Trauma and Injury
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    • v.34 no.4
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    • pp.225-232
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    • 2021
  • Purpose: Trauma is the top cause of death in people under 45 years of age. Deaths from severe trauma can have a negative economic impact due to the loss of people belonging to socio-economically active age groups. Therefore, efforts to reduce the mortality rate of trauma patients are essential. The purpose of this study was to investigate preventable mortality in trauma patients and to identify factors and healthcare-related challenges affecting mortality. Ultimately, these findings will help to improve the quality of trauma care. Methods: We analyzed the deaths of 411 severe trauma patients who presented to Gachon University Gil Hospital regional trauma center in South Korea from January 2015 to December 2017, using an expert panel review. Results: The preventable death rate of trauma patients treated at the Gachon University Gil Hospital regional trauma center was 8.0%. Of these, definitely preventable deaths comprised 0.5% and potentially preventable deaths 7.5%. The leading cause of death in trauma patients was traumatic brain injury. Treatment errors most commonly occurred in the intensive care unit (ICU). The most frequent management error was delayed treatment of bleeding. Conclusions: Most errors in the treatment of trauma patients occurred in early stages of the treatment process and in the ICU. By identifying the main causes of preventable death and errors during the course of treatment, our research will help to reduce the preventable death rate. Appropriate trauma care systems and ongoing education are also needed to reduce preventable deaths from trauma.

Comparison of mortality between open and closed pelvic bone fractures in Korea using 1:2 propensity score matching: a single-center retrospective study

  • Jaeri Yoo;Donghwan Choi;Byung Hee Kang
    • Journal of Trauma and Injury
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    • v.37 no.1
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    • pp.6-12
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    • 2024
  • Purpose: Open pelvic bone fractures are relatively rare and are considered more severe than closed fractures. This study aimed to compare the clinical outcomes of open and closed severe pelvic bone fractures. Methods: Patients with severe pelvic bone fractures (pelvic Abbreviated Injury Scale score, ≥4) admitted at a single level I trauma center between 2016 and 2020 were retrospectively analyzed. Patients aged <16 years and those with incomplete medical records were excluded from the study. The patients were divided into open and closed fracture groups, and their demographics, treatment, and clinical outcomes were compared before and after 1:2 propensity score matching. Results: Of the 321 patients, 24 were in the open fracture group and 297 were in the closed fracture group. The open fracture group had more infections (37.5% vs. 5.7%, P<0.001) and longer stays in the intensive care unit (median 11 days, interquartile range [IQR] 6-30 days vs. median 5 days, IQR 2-13 days; P=0.005), but mortality did not show a statistically significant difference (20.8% vs. 15.5%, P=0.559) before matching. After 1:2 propensity score matching, the infection rate was significantly higher in the open fracture group (37.5% vs. 6.3%, P=0.002), whereas the length of intensive care unit stay (median 11 days, IQR 6-30 days vs. median 8 days, IQR 4-19 days; P=0.312) and mortality (20.8% vs. 27.1%, P=0.564) were not significantly different. Conclusions: The open pelvic fracture group had more infections than the closed pelvic fracture group, but mortality was not significantly different. Aggressive treatment of pelvic bone fractures is important regardless of the fracture type, and efforts to reduce infection are important in open pelvic bone fractures.

Development of a finite Element Model for Studying the Occupant Behavior and Injury Coefficients of a Large-sized Truck (대형트럭 승객거동과 상해치 해석을 위한 유한요소모델의 개발)

  • O, Jae-Yun;Kim, Hak-Deok;Song, Ju-Hyeon
    • Transactions of the Korean Society of Mechanical Engineers A
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    • v.26 no.8
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    • pp.1577-1584
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    • 2002
  • This paper develops a finite element model for studying the occupant behavior and injury cofficients of a large-sized cab-over type truck. Since it does not have a room to absorb collision energy and deformation in front of the passenger compartment the deformation is directly transmitted to the passenger compartment. Moreover, since its steering column is attached on the frame, severe deformation of the frame directly affects on the steering wheel's movement. Therefore, if the occupant behavior and injury coefficients analysis is performed using a finite element model developed based on a sled test, it is very difficult to expect acquiring satisfactory results. Thus, the finite element model developing in this paper is based on the frontal crash test in order to overcome the inherent problems of the sled test based model commonly used in the passenger car. The occupant behavior and injury coefficients analysis is performed using PAM-CRASH installed in super-computer SP2. In order to validate the reliability of the developed finite element model, a frontal crash test is carried out according to a test method used fur developing truck occupant's secondary safety system in european community and japan. That is, test vehicle's collision direction is vertical to the rigid barrier and collision velocity is 45kph. Thus, measured vehicle pulses at the lower parts of the left and right B-pilla., dummy chest and head deceleration profiles, HIC(head injury criterial) and CA(chest acceleration) values, and dummy behavior from the frontal crash test are compared to the analysis results to validate reliability of the developed model.

Analysis of Posterior Cervical Fixation and Fusion in Subaxial Cervical Spine Injury (중하부 경추손상에서 후방 경추 내고정술 및 골유합술의 분석결과)

  • Lee, Dong Hoon;Song, Geun Sung
    • Journal of Korean Neurosurgical Society
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    • v.30 no.12
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    • pp.1388-1393
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    • 2001
  • Objective : In the retrospective analyzing 19 consecutive patients with subaxial cervical spine(C3~T1) injury treated by posterior cervical fixation and fusion, clinical manifestation, radiologic finding, operative technique, and postoperative results following 6 months were analyzed. Materials and Methods : Most common fracture level was C4-5, mean age 41, and male to female ratio 13 : 6. The most common cause of injury was motor vehicle accident(17 cases). In 19 cervical procedures, interspinous triple wiring was done in 14 cases, lateral mass plating in 5 cases, and additional anterior fusion in 2 cases. Results : Twelve weeks after operation, all cases were reviewed by plain cervical radiogram. In 17 cases that treated by posterior fusion only, 14 cases(81%) had kyphotic angle change less than $5^{\circ}$, 2 cases(12%) $5-20^{\circ}$, and 1 case(6%) more than $20^{\circ}$. Overall fusion rate was 88%, and there was no significant difference of bone fusion rate between autogenous bone graft and allogenous bone graft. Conclusion : In the case of severe posterior column injury or displacement, posterior approach seems superior to anterior approach, but in the case of combined anterior column injury, anterior approach is considered necessary. In this study, posterior fixation and fusion might be acceptable procedure for subaxial cervical fracture and dislocation, owing to its high fusion rate, low kyphotic angulation and low operation related complication rate.

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Treatment of Posteolareral Rotatory Instability of the Knee (슬관절 후외방 불안정성의 치료)

  • Kim, Jin Goo
    • Journal of the Korean Arthroscopy Society
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    • v.15 no.2
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    • pp.146-154
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    • 2011
  • Injury of posterolateral corner is unusual, but it can cause disability due to severe instability and cartilage damage. However, the anatomical structures, diagnosis and treatment have not defined clearly yet. Posterolateral corner injury is regarded as the one of main factor to the results of failure in cruciate ligament reconstcution if it was undiagnosed and untreated. Diagnosis of postetolateral corner injury is consists of physical exam, radiographic finding, MRI, and arthroscopic findings. The treatment method of of postetolateral corner injury depends on the time and severity of injury. Anatomical reconstruction of posterolateral corner shows the better clinical outcome than non anatomical reconstructions, but the clinical results of long term follow up is still needed. Therefore, the aim of this article is to review the recent literatures and to organize diagnosis and treatment of posterolateral corner injury.

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Analysis of Seasonal Injuries in Professional Football Player (프로 축구 팀의 월별 부상실태에 관한 조사)

  • Lee, Kyung-Tai;Choi, Byung-Ok;Kim, Jin-Su
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.5 no.2
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    • pp.135-140
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    • 2006
  • Purpose: To investigate the risk exposure, risk of injury, and injury pattern of football players in seasonal variation. We purposed to expect the injury and its' prevention. Material and Methods: The professional football club(45 players) in Seoul were followed prospectively throughout 2005, January to 2005, December. Injury pattern and incidence were recorded. Results: Total 157 injuries were recorded. Major injuries which could not attend to game and training were 87 cases. Most severe month was June about 16 injuries(18.4%). And, the competitive season injuries were 46(52.9%) in March, April, August and September. Especially, ankle sprain and contusion injuries were common cause of absence in game. And, thigh muscle group injuries had a high risk of reinjury, because of treat insufficiently. Conclusions: We enhance the ability of the soccer team by prevention and education for injuries, especially in season.

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Finger Injury by Green Onion Cutting Machine (파절기에 의한 수지손상)

  • Yim, Young Min;Oh, Deuk Young;Jung, Sung No;Rhie, Jong Won;Ahn, Sang Tae;Kwon, Ho
    • Archives of Plastic Surgery
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    • v.36 no.1
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    • pp.46-50
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    • 2009
  • Purpose: Finger injury by green onion cutting machine is one of the common hand injuries in the kitchen. It has a unique feature: there are multiple parellel laceration 3 - 5 mm wide. There are two directions of injuries(vertical, oblique). It may involve bone, tendon, nerve, and vessel injuries. We discuss its management and the long - term progress. Methods: We have treated six patients from 2003 to 2007. We carried out low tension approximation with thin suture materials to avoid ischemia and performed the additional operation as nail bed repair, tenorrhaphy, open reduction, vessel anastomosis, and composite graft. We reviewed the record of initial injury and collected the follow - up record. Results: They were all middle aged - women who had worked in the kitchen. Right hand was dominent over left hand. The ratio of the directions was 3 : 3 (vertical : oblique). They were all competely healed although there were three atrophy, four hyperesthesia, and one nail deformity. Conclusion: Finger injury by green onion cutting machine is a unique pattern of laceration with various accompanied injuries. It may look like a severe form of injury, but in most cases have relatively favorable progress. We have to perform careful examination of accompanied injuries and carry out the proper management. First and foremost, the user especially in the middle aged women should be warned to be careful in handling this risky machine.

Characteristics of Wrist Injuries in Snowboarding (스노보드 손상 환자에 있어서 손목 손상의 특성)

  • Kim, Yeong Jun;Lee, Kang Hyun;Cha, Kyoung Chul;Kim, Hyun;Hwang, Sung Oh;Oh, Jin Rok
    • Journal of Trauma and Injury
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    • v.22 no.1
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    • pp.29-36
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    • 2009
  • Purpose: The purpose of this study was to analyze the characteristics and severity of wrist injuries in snowboarding. Methods: December 2005 to February 2008, Snowboarders who experienced wrist injures were included in this study. On the basis of the medical records and radiographic evaluation, the severity of distal radius fracture was classified according to the Arbeitsgemeinschaft fur Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) classification. Results: Most of the injured snowboarders were a either of the beginner (35 cases, 46.1%) or the intermediate (27 cases, 35.5%) level. The most common cause of injury in snowboarding was a slip down (60 cases, 78.9%). Comminuted and articular fractures classified as AO types A3, B, and C, which required surgical reduction, made up 42.3% of the distal radial fractures in snowboarders. When we analyzed the differences in severity between the educated and the non-educated groups, an A2 type injury in the AO classification was the most common type of injury in the educated group (20 cases, 38.5%), it means less severe fractures ocurred in the educated group (p=0.045). The most frequent injury mechanism of fractures was slip down (48 cases, 63.2%), and a slip down backwards was the dominant type of slip down (36 cases, 75.0%) (p=0.031). Conclusion: Among the snowboarders in this study who suffered self-down injury to the wrist, more fractures were associated with a backwards slip down than with a forward slip down due to over extension. For educated snowboarders the severity of fracture was lower than it was for uneducated snowboarders.

Profiling of Recovery Efficiencies for Three Standard Protocols (FDA-BAM, ISO-11290, and Modified USDA) on Temperature-Injured Listeria monocytogenes

  • Lee, Hai Yen;Chai, Lay Ching;Pui, Chai Fung;Wong, Woan Chwen;Mustafa, Shuhaimi;Cheah, Yoke Kqueen;Issa, Zuraini Mat;Nishibuchi, Mitsuaki;Radu, Son
    • Journal of Microbiology and Biotechnology
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    • v.21 no.9
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    • pp.954-959
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    • 2011
  • There have been a number of studies conducted in order to compare the efficiencies of recovery rates, utilizing different protocols, for the isolation of L. monocytogenes. However, the severity of multiple cell injury has not been included in these studies. In the current study, L. monocytogenes ATCC 19112 was injured by exposure to extreme temperatures ($60^{\circ}C$ and $-20^{\circ}C$) for a one-step injury, and for a two-step injury the cells were transferred directly from a heat treatment to frozen state to induce a severe cell injury (up to 100% injury). The injured cells were then subjected to the US Food and Drug Administration (FDA), the ISO-11290, and the modified United States Department of Agriculture (mUSDA) protocols, and plated on TSAyeast (0.6% yeast), PALCAM agar, and CHROMAgar Listeria for 24 h or 48 h. The evaluation of the total recovery of injured cells was also calculated based on the costs involved in the preparation of media for each protocol. Results indicate that the mUSDA method is best able to aid the recovery of heat-injured, freeze-injured, and heat-freeze-injured cells and was shown to be the most cost effective for heat-freeze-injured cells.