• Title/Summary/Keyword: Severe injury

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Effectiveness of Simple Trauma Team Activation Criteria on Prognosis of Severe Trauma Patients (단순 외상팀 활성화 조건이 중증 외상 환자의 치료 결과에 미치는 영향)

  • Lee, Dong Keon;Lee, Kang Hyun;Cha, Kyoung Chul;Park, Kyoung Hye;Choi, Han Joo;Kim, Hyun;Hwang, Sung Oh
    • Journal of Trauma and Injury
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    • v.22 no.1
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    • pp.71-76
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    • 2009
  • Purpose: The goal of this study was to compare the outcome of the after trauma team (AfterTT) group to the before trauma team (BeforeTT) group. Methods: All trauma patients who visited to emergency room (ER) between July 1, 2006 and February 29,2008 based on trauma registry, with systolic blood pressure (SBP) < 90 mmHg or GCS < 9 were included in this study. We compared the amount of packed RBC transfusion, the ER stay time, the ER visit to CT evaluation time, the ER visit to operation time, the length of ICU stay, the length of hospital admission and the survival discharge rate between the AfterTT group and the BeforeTT group. Patients with brain injuries had little chance of survival. Burn patients, who visited the ER 24 hours after injury and patients who were dead on arrival (DOA) were excluded from this study. Results: Total of 93 patients were included in this study: 42 in the AfterTT group and 51 in the BeforeTT group. The AfterTT group and the Before TT group showed no differences in Revised Trauma Score (RTS) and mean age. The amount of packed RBC transfusion was lower in the AfterTT group, but no statistically significant difference was noted (AfterTT 11${\pm}$11units, BeforeTT 16${\pm}$15units, p=0.136). The ER visit to operation time was shorter in the AfterTT group, but there were no statistically significant difference between the groups (AfterTT 251${\pm}$223 minutes, BeforeTT 486${\pm}$460 minutes, p=0.082). The length of ICU stay was shorter in the AfterTT group, but the difference was not statistically significant (AfterTT 11${\pm}$12 days, Before TT 15${\pm}$30 days, p=0.438). The length of Hospital admission was shorter in the AfterTT group (AfterTT 43${\pm}$37 days, BeforeTT 68${\pm}$70 days, p=0.032), but this difference was not statistically significant. Conclusion: Simple Trauma team activation criteria decreased the amount of packed RBC transfusion and the hospital admission duration. Hemodynamic instability (SBP < 90 mmHg) and decreased mental state (GCS<9) are good indices for activating the trauma team.

Clinical Results of Different Myocardial Protection Techniques in Aortic Stenosis

  • Lee, Jung Hee;Jeong, Dong Seop;Sung, Kiick;Kim, Wook Sung;Lee, Young Tak;Park, Pyo Won
    • Journal of Chest Surgery
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    • v.48 no.3
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    • pp.164-173
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    • 2015
  • Background: Hypertrophied myocardium is especially vulnerable to ischemic injury. This study aimed to compare the early and late clinical outcomes of three different methods of myocardial protection in patients with aortic stenosis. Methods: This retrospective study included 225 consecutive patients (mean age, 65{\pm}10 years; 123 males) with severe aortic stenosis who underwent aortic valve replacement. Patients were excluded if they had coronary artery disease, an ejection fraction <50%, more than mild aortic regurgitation, or endocarditis. The patients were divided into three groups: group A, which was treated with antegrade and retrograde cold blood cardioplegia; group B, which was treated with antegrade crystalloid cardioplegia using histidine-tryptophan-ketoglutarate (HTK) solution; and group C, treated with retrograde cold blood cardioplegia. Results: Group A contained 70 patients (31.1%), group B contained 74 patients (32.9%), and group C contained 81 patients (36%). The three groups showed significant differences with regard to the proportion of patients with a New York Heart Association functional classification ${\geq}III$ (p=0.035), N-terminal pro-brain natriuretic peptide levels (p=0.042), ejection fraction (p=0.035), left ventricular dimensions (p<0.001), left ventricular mass index (p<0.001), and right ventricular systolic pressure (p <0.001). Differences in cardiopulmonary bypass time (p=0.532) and aortic cross-clamp time (p=0.48) among the three groups were not statistically significant. During postoperative recovery, no significant differences were found regarding the use of inotropes (p=0.328), mechanical support (n=0), arrhythmias (atrial fibrillation, p=0.347; non-sustained ventricular tachycardia, p=0.1), and ventilator support time (p=0.162). No operative mortality occurred. Similarly, no significant differences were found in long-term outcomes. Conclusion: Although the three groups showed some significant differences with regard to patient characteristics, both antegrade crystalloid cardioplegia with HTK solution and retrograde cold blood cardioplegia led to early and late clinical results similar to those achieved with combined antegrade and retrograde cold blood cardioplegia.

Usefulness of End-tidal Carbon Dioxide as a Predictor of Emergency Intervention in Major Trauma Patients (중증 외상 환자에서의 응급중재술 시행 예측 인자로서의 호기말 이산화탄소 분압의 유용성)

  • Kim, Sung Ho;Kim, Seunghwan;Lee, Jae Gil;Chung, Sung Phil;Kim, Seung Ho
    • Journal of Trauma and Injury
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    • v.27 no.4
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    • pp.133-138
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    • 2014
  • Purpose: If the survival of patients suffering from severe blunt trauma is to be improved, appropriate interventions should be taken immediately. The purpose of this study is to evaluate the clinical utility of end-tidal carbon dioxide ($ETCO_2$) as a surrogate marker for predicting both the need for intervention and the prognosis. Methods: This is a prospective observational study. Nasal cannula was applied to measure $ETCO_2$, and the following parameters, which are known to be related to the prognosis for a patient, were recorded: injury severity score (ISS), revised trauma score (RTS), arterial blood gas (ABG), lactate, and hemoglobin (Hb). To evaluate the outcome, we investigated the details of emergent interventions and expired patients. Results: A total of 93 patients were enrolled in this study. Emergent intervention was significantly associated with systolic blood pressure (sBP, p-value=0.001), $ETCO_2$ (p-value<0.001), serum lactate level (p-value<0.001), pH (p-value< 0.003), $HCO_3$ (p-value=0.004), base excess (p-value<0.002), ISS (p-value<0.001) and RTS (p-value=0.005). In the multivariate logistic regression, only $ETCO_2$ (odds ratio (OR): 0.897, 95% confidence interval (CI): 0.792-0.975, p-value= 0.048) and ISS (OR: 1.132, 95% CI: 1.053-1.233, p-value=0.002) were associated with emergent intervention whereas $ETCO_2$ (p-value=0.973) and ISS (p-value=0.511) were not statistically significant in predicting the survival of patients in the univariate analysis. An optimal ETCO cut-off of 29 mmHg on the ROC curve was determined, with the area under the ROC curve (AUC) being 0.824 (0.732-0.917)]. Conclusion: This study has revealed that $ETCO_2$, which can be rapid and easily measured through a nasal cannula, and the ISS may be prognostic indicators of emergent interventions in Emergency Departments.

Effect of Supplementary Heating on the Night Air Temperature and Growth of Strawberry Under Greenhouse Cultivation (딸기 반촉성재배(半促成栽培) 보조가온(補助加溫)이 야온(夜溫)과 생육(生育)에 미치는 영향(影響))

  • Suh, Hyo-Duk;Park, Sang-Keun;Kwon, Young-Sam
    • Korean Journal of Environmental Agriculture
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    • v.2 no.2
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    • pp.114-119
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    • 1983
  • Several supplementary heating methods were investigated to find their effects on night air temperature, injury in plant, growth and yield with Hokowase strawberry(Fragaria grandiflora) under greenhouse, during early spring season in 1981 and 1982. Kerosene lamp as a supplementary heating was not suitable because of its severe injury on strawberry plants, danger of accidental fire and bad smell. Paraffine candle and electric wire heating did not injure on strawberry plant, raised the minimum air temperature in greenhouse at night, enhanced growth, flowering and harvesting time of strawberry. Paraffine candle was effective as a supplementary heating method for short period growing under greenhouse, whereas electric wire heating was suitable for long period cultivation.

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Effects of Mycelial Extract of Phellinus linteus on Ethanol-Induced Liver Injury in Rats (알코올성 간 손상에 대한 상황버섯 배양균사체 추출물의 효능)

  • Choi, Byung-Tae;Choi, Yung-Hyun;Gil, Young-Gi
    • Journal of Life Science
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    • v.16 no.6
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    • pp.978-983
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    • 2006
  • We investigated the anti-inflammatory effects of mycelial culture extract from Phellinus linteus (MCPL) for suppression in the process of ethanol-induced inflammation in rat liver. Levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were significantly increased in the serum of ethanol-treated rats compared to normal. However, the level of ALT was arrested markedly in ethanol-treated rats with MCPL compared to ethanol alone treated control ones. Severe histopathological changes of liver such as cloudy swelling, inflammatory cells infiltration, Kupffer cell reaction and focal necrosis were demonstrated in the rats challenged with ethanol compared with normal. Fewer scores of these changes were observed in MCPL-treated rat with recovered glycogen in centrolobular region of hepatic lobule. The Western analysis showed that the expression of inflammatory proteins such as cyclooxygenase (COX)-1, COX-2, inducible nitric oxide synthase (iNOS), tumor necrosis factor $(TNF)-{\alpha}$ were increased in the ethanol-treated rat. But decline of COX-2 and iNOS expression were observed in MCPL-treated rat. Immunohistochemical analysis showed that the expression of COX-2 and $TNF-{\alpha}$ tended to increase in ethanol-treated rat, but decrease of these reactions were induced by MCPL treatment. These results suggest that MCPL may act as a protective agent for alcohol-induced liver injury through a regulating inflammation-related proteins.

Powdered Wound Dressing Materials Made from wild Silkworm Antheraea pernyi Silk Fibroin on Full-skin Thickness Burn Wounds on Rats

  • Kim, Min-Keun;Yoo, Ki-Yeon;Kwon, Kwang-Jun;Kim, Seong-Gon;Park, Young-Wook;Lee, Kwang-Gill;Jo, You-Young;Kweon, Hae-Yong
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.36 no.3
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    • pp.111-115
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    • 2014
  • Purpose: This study evaluated powdered burn wound dressing materials from wild silkworm fibroin in an animal model. Methods: Fifteen rats were used in this experiment. Full-thickness $2{\times}2cm$ burn wounds were created on the back of rats under anesthesia. In the two experimental groups, the wounds were treated with two different dressing materials made from silkworm fibroin. In the Control Group, natural healing without any dressing material was set as control. The wound surface area was measured at five days, seven days and 14 days. Wound healing was evaluated by histologic analysis. Results: By gross observation, there were no infections or severe inflammations through 14 days post-injury. The differences among groups were statistically significant at seven days and 14 days, postoperatively (P<0.037 and 0.001, respectively). By post hoc test, the defect size was significantly smaller in experimental Group 1 compared with the Control Group and experimental Group 2 at seven days postoperatively (P=0.022 and 0.029, respectively). The difference between Group 1 and Group 2 was statistically significant at 14 days postoperatively (P<0.001). Group 1 and control also differed significantly (P=0.002). Group 1 showed a smaller residual scar than the Control Group and Group 2 at 14 days post-injury. Histologic analysis showed more re-epithelization in Groups 1 and 2 than in the Control Groups. Conclusion: Burn wound healing was accelerated with silk fibroin spun by wild silkworm Antheraea pernyi. There was no atypical inflammation with silk dressing materials. In conclusion, silk dressing materials can be used for treatment of burn wound.

Review on the Causes of Headache in Hyungsang Medicine (두통(頭痛)의 원인에 따른 형상의학적(形象醫學的) 고찰 -동의보감(東醫寶鑑) 두문(頭門)을 중심으로)

  • Lee, Dong-Min;Park, Seong-Ha;Lee, Yong-Tae
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.21 no.4
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    • pp.835-841
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    • 2007
  • The followings are concluded from the treatment of headache in Hyungsang medicine, focussed on 11 kinds of headaches in Donguibogam. Headache is classified into overall headache and migraine according to the affected region. The causes are divided into exogenous affection and internal injury; The former brings on headache due to Wind-Cold and headache due to Damp-Heat. The latter, reversal headache, headache due to adverse rising of phlegm, headache due to regurgitation of Gi, headache due to excessive Heat, headache due to excessive Damp, true headache, and alcoholic headache. Headache due to internal injury generally tends to show deficiency syndrome with external affection. Headache due to exogenous affections is common to those who have big head or white skin and to Bangkwang type, and woman. The primary causes are Wind-Cold and Wind-Heat. When the body is observed in the perspective of eight phases, Damp-Heat is to be produced in the front, and Dry-Damp, in the back. Headache due to Damp-Heat is susceptible to Yangmyeong meridian type whose body develops more in the front and to woman. In the perspective of the upper and the lower, Yangdu(that is, head) is related to Eumdu(that is, glans of penis). Headache is also caused by the problems of Eumdu ,such as deficiency of Essence in man, pathologic change of uterus in women, and San syndrome in lower abdomen. In the case of man, headache is frequently severe and difficult to treat because head is a root for man. Disharmony of Gi and blood between the right and the left brings out migraine and headache due to regurgitation of Gi. Migraine is usually accompanied by symptoms of exogenous affection and often afflicts Gi-type, Shin-type, Soyang meridian type, deer type, and Dam-type. Headache due to regurgitation of Gi is brought by Gi deficiency or blood deficiency so that symptoms of exogenous affection do not show. It is mainly common with old people and those who have sunken eyes induced by deficiency of stomach Gi. In the perspective of the upper, the middle, and the lower, the pathologic change of head, chest and abdomen also bring about headache. The pathologic cause of head is Wind-Heat ,which triggers overall headache, migraine, headache due to Wind-Cold, headache due to excessive Heat, The pathogen of chest is phlegm-Fire and brings out headache due to Damp-Heat and headache due to adverse rising of phlegm. The pathologic factor in abdomen is Cold-Damp and produces headache due to adverse rising of phlegm and headache due to excessive Damp. In case of women, headache is generally caused by phlegm-Fire and retention of undigested food.

Arthroscopic Management in the Athletic Elbow Lesion (주관절 병변이 있는 운동 선수에서 관절경적 처치)

  • Moon Young Lae;Ha Sang Ho;You Jae Won;Joo Jeong Yong;Kim Dong Hui
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.1 no.1
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    • pp.97-101
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    • 2002
  • Purpose : To describe clinical results and improvement of range of motion and pain after arthroscopic treatment for the athletic elbow lesion. Materials and Methods : We reviewed 13 cases of functional restriction of the elbow motion, who all patients were treated by conservative treatment during than 6 months but failed. We performed arthroscopic osteophytectomy, capsular release, spur excision. The interval from injury to operation was average of 13 months (range, eight to sixteen months). We used the Broberg and Morrey functional rating score system in evaluating result. The follow-up period averaged 6 months. Results : Arthroscopic finding that moderative to severe synovitis in all cases, intraarticular loose body in 9 cases, olecranon bony spur in 2 cases, was observed. All cases were successfully improved in range of motion and pain without in any further operation. Preoperative average score was 65 and postoperative average score was 89.4 in Broberg and Morrey functional rating score. Conclusions : Arthroscopic treatment appear to be satisfactory management modality due to diagnose the casative factor and reduce the injury around the elbow joint in painful elbow lesion. Elbow arthroscopy appears to be a safe and effective treatment for athletes, allowing easy return to participation in sports.

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Herbicidal Activity of Natural Compound Chrysophanic Acid Under the Greenhouse Condition (온실조건에서 천연물질 Chrysophanic Acid의 제초활성)

  • Kang, Chung-Kil;Lee, Sang-Beom;Lee, Byung-Mo;Nam, Hong-Sik;Lee, Yong-Ki;Jee, Hyeong-Jin;Hong, Moo-Ki;Rho, Yeong-Deok;Choi, Jung-Sup
    • Korean Journal of Weed Science
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    • v.31 no.1
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    • pp.112-117
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    • 2011
  • A series of experiments was conducted to investigate the herbicidal activity of natural compound chrysophanic acid under the greenhouse condition in 16 weed species. Chrysophanic acid showed non-selective herbicidal activity. While chrysophanic acid exhibited severe injury by foliar treatment, little or no injury was found by the soil treatment. Among the tested weeds, the most effective activity was found in grass and broad leaf weeds, a lower significant difference in herbicidal activity was found in sedge. At early post-emergence, weeds appeared to be very susceptible to chrysophanic acid with $2,000{\mu}g\;mL^{-1}$. The higher the natural compound concentrations, the lower weed growth. At middle post-emergence, weeds appeared to be very effective to chrysophanic acid with $30,000{\mu}g\;mL^{-1}$.

Analysis on Usefulness of Various Free Flaps for Primary Reconstruction on Fourth Degree Burn (4도 화상에서 다양한 유리피판술을 이용한 1차 재건 방법의 유용성 고찰)

  • Lee, Ju Ho;Shin, Se Ho;Kim, Hyeon Jo;Lee, Seong Joo;Kim, Seong Hwan;Suh, In Suck;Kim, Jae Hyun
    • Journal of the Korean Burn Society
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    • v.23 no.2
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    • pp.54-59
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    • 2020
  • Purpose: A fourth degree burn is a full-thickness burn of the skin usually accompanied by damage to deep structures and commonly results in extensive damage to surrounding tissues which makes the treatment of the wound difficult. Coverage of these wound using free flap is known to effective but not commonly used. The purpose of our study is to review our experience and suggest early application of free flap surgery. Methods: A retrospective review was performed from 2010 to 2019, on a total of 34 fourth degree burn patients undergone free flap surgery as primary treatment in our hospital. We reviewed the location of the injury, etiology, TBSA (%), Presence of osteomyelitis, flap choice, complications, period of injury to surgery and healing. Results: Using free flap as a primary reconstrcuction, the outcome is satisfactory. The treatment period was shortened, and there was less loss of function due to complications. Also the incidence of osteomyelitis and amputation was significantly low. Conclusion: Applying free flap surgery as soon as possible in fourth degree burns is effective, such as reducing complications such as infection, reducing amputation, shortening treatment period, and preventing severe sequelae.