• Journal of Trauma and Injury
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• v.22 no.2
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• pp.218-226
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• 2009

Purpose: In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative management. The blood products must be expedited and efficiently to patients in impending shock caused by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically, based on the clinician' and has not been guided by objective parameters, but own opinion, that may result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome. This article presents quickly assessable predictive factors for determining if a blood transfusion is required to improve outcomes in multiple blunt trauma patients admitted to the emergency room. Methods: In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion were subjected to univariate and multivariate logistic regression analysis. Results: Of blunt trauma patients, 9.2% (26/282), received red blood cells in the first 24 hours of care. Univariate analysis revealed significant associations between blood transfused and heart rate (HR) > 100 beats/min, respiratory rate (RR) > 20 breaths/min, Glasgow Coma Scale (GCS) < 14, Revised Trauma Score (RTS) < 11, white blood cell count (WBC) < 4000 or > 10000, and initial abnormal portable trauma series (Cspine lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR > 100 beats/min (EXP 3.2), GCS < 14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors. Conclusion: In our study, systolic blood pressure (SBP) < 90 mmHg, old age > 65 years, hemoglobin < 13g/dL, mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR > 100 beats/min, and GCS < 14 were quickly assessable useful factors for predicting a need for early blood transfusion in blunt trauma patients visiting the emergency room.

• Journal of Preventive Medicine and Public Health
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• v.41 no.6
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• pp.407-412
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• 2008

Objectives: The purpose of this study was to evaluate the relationship of nonalcoholic fatty liver and cardiovascular risk factors. Methods: This study was conducted to investigate the association of nonalcoholic fatty liver and cardiovascular risk factors for adult men (n=2976) and women (n=2442) who were over 19 years old, after excluding the HBsAg(+) or anti-HCV(+) patients and the men and women with increased alcohol intake (men: 40g/week, women: 20g/week). Results: Compared with the normal liver subjects, the nonalcoholic fatty liver subjects showed a significantly increased frequency of abnormal systolic blood pressure (${geq}120mmHg$), fasting blood sugar (${\geq}100mg/dL$), total cholesterol ($({\geq}200 mg/dL$), triglyceride ($({\geq}150mg/dL$), high density lipoprotein cholesterol (<40 mg/dL), low density lipoprotein cholesterol ($({\geq}130g\; m/dL$) and abdominal obesity in men, and all these measures were significantly increased in the women except for abnormal HDL cholesterol. After adjusting for the body mass index, age, smoking, exercise and a nonalcoholic liver, the odds ratios of an abnormal waist hip ratio were 1.35(95% Confidence Interval=1.05-4.72) in the mild fatty liver, 1.61 (1.19-2.18) in the moderate fatty liver, 2.77(1.57-4.92) in the severe fatty liver compared with a normal liver. The adjusted odds ratios for abnormal fasting blood sugar were 1.26(1.03-1.53) in the mild fatty liver, 1.62(1.27-2.06) in the moderate fatty Iiver and 1.77(1.12-2.78) in the severe fatty liver. The adjusted odds ratios for abnormal triglyceride were 1.38(1.11-1.72) in the mild fatty liver, 1.73(0.33-2.24) in the moderate fatty liver and 1.91 (1.17-3.10) in the severe fatty liver of men. Adjusted odds ratios for abnormal triglyceride were 1.50(1.04-2.15) in mild, 1.71(1.07-2.68) in moderate, 1.81(0.69-4.38) in severe fatty liver of women. Conclusions: The nonalcoholic fatty liver subjects had more cardiovascular risk factors compared with the normal liver subjects. Thus, prevention and treatment of the nonalcoholic fatty liver is necessary by lifestyle modifications such as restriction of alcohol intake, no smoking, exercise and adequate eating habits.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1391-1398
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• 1992

The hypothesis tested is that shifts in pH, induced when a cardioplegic solution is oxygenated, can be detrimental. The object of this study is to evaluate the effect of the pH of the oxygenating cardioplegic solution on postischemic recovery in the isolated rat heart. Either 100% oxygen or 95% oxygen: 5% carbon dioxide was added to the cardioplegic solution[St. Thomas` Hospital No. 2] and determined postischemic recovery of isolated rat hearts after 2 hours and 3 hours of 20oC cardioplegic protected ischemia. Heart were arrested and reinfused every 30 minutes throughout the ischemic period with cardioplegic solution. When 100% oxygen was added, the pH of the cardioplegic solution increased from 7.8[no oxygen] to 8.5[100% oxygen] without any change in postischemic functional recovery. But when 95% oxygen ; 5% carbon dioxide was added, the pH of the cardioplegic solution reversely decreased to 6.84 in the 2-hour ischemic group and 6.73 in the 3-hour ischemic group, associated with improved postischemic functional recovery. After 2-hour ischemia, systolic pressure improved from 88.2$\pm$3.7%[no oxygen] and 88.7$\pm$3.8%[100% oxygen] to 96.6$\pm$1.8%[95% oxygen : 5% carbon dioxide], p<0.05, aortic flow from 43.3$\pm$3.1% and 38.4$\pm$10.6% to 74.5$\pm$5.0%, p<0.001, cardiac output from 55.5$\pm$4.6% and 47.4%$\pm$10.6% to 73.1$\pm$4.6%, p<0.05, stroke volume from 62.7$\pm$4.6% and 52.0$\pm$10.1% to 77.2$\pm$4.6%, p<0.05, and dP/dT from 59.3$\pm$7.2% and 56.7$\pm$7.6% to 78.9$\pm$4.6%, p<0.05. The infused amount of the cardioplegic solution during 2-hour ischemic period was similar in three groups. After 3-hour ischemia, cardiac output improved from 17.0$\pm$3.8%[no oxygen] to 45.9$\pm$7.5%[95% oxygen: 5% carbon dioxide], p<0.05, and stroke volume from 21.0$\pm$3.9%[no oxygen] to 50.1$\pm$6.6%[95% oxygen: 5% carbon dioxide], p<0.01. In conclusion, the St. Thomas` Hospital No. 2 cardioplegic solution should be oxygenated but with 95% oxygen: 5% carbon dioxide and not 100% oxygen because of the additive effect of a relatively "Acidotic" pH.t; pH.

• 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.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.57-62
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• 2010

Purpose: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. Methods: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. Results: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. Conclusion: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.

• 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.

• Journal of Trauma and Injury
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• v.27 no.4
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• pp.126-132
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• 2014

Purpose: The field trauma triage for injured patients is essential for trauma care system. In this study, agreement of patient evaluation between by prehospital EMS personnel and by hospital staffs and the appropriateness of prehospital triage were evaluated. Methods: This observational study was conducted from September to October 2012 for 5 weeks. During this period, EMT evaluated patient's severity according to guideline for field triage and recorded. Same guideline was applied in 26 hospitals for patients with EMS use. Kappa statistics were used to measure agreement for each item of guideline. Finally, over-triage and under-triage rate of EMT were calculated. Results: During study period, total 3,106 patients were transferred to 26 hospital emergency departments with EMS use. Kappa statistics for "vital signs" items were 0.45 for mentality lower than V and 0.44 for systolic blood pressure lower than 90 mmHg as a moderate agreement. In "anatomy of injury" items Kappa statistics were very low. In "mechanism of injury" items Kappa statistics were 0.28 for high-rise fall down and 0.27 for high energy traffic accident but in other items Kappa statistics were very low. 362 patients (12.0%) were over-triaged and 281 patients (9.3%) were under-triaged. Conclusion: Field triage can be applied but need to evaluate and modify in order to become accurate and sensitive for decision of transportation.

• The Korean Journal of Nuclear Medicine
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• v.12 no.2
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• pp.23-31
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• 1978

Hyperthyroidism may be defined as those clinical conditions which result from an increase in the circulating levels of one or both thyroid hormones. Hyperthyroidism in broad sense could be classified with toxic diffuse goiter, toxic adenomatous goiter, and toxic multinodular goiter on the basis of the circulating thyroid hormone levels. For this study, the subject included 94 cases with hyperthyroidism were presented in 77 with toxic diffuse goiter, 8 with toxic adenomatous goiter, and 9 with toxic multinodular goiter on the levels of $^{125}IT_3$ resin uptake rate and serum thyroxine ($T_4$). The observed results were as follows: 1) In the cases of hyperthyroidism including toxic diffuse goiter, toxic adenomatous goiter, and toxic multinodular goiter, 20.21% of the patients were male and 79.79% female. The majority of the patients were in 2nd to 4th decades of their lives. 2) There were objective signs clearly manifested in hyperthyroidism including toxic diffuse goiter and toxic adenomatous goiter which were rare in the multinodular goiter. The clinical signs in toxic diffuse and toxic adenomatous goiter included wide pulse pressure, tachycardia, systolic murmur, exophthalmos, tremor and warm skin etc. (Table 3.) 3) The most freauent complaints of the patients with hyperthyroidism were palpitation, weight loss, increased appetite, perspiration, heat intolerance, nervousness, exertional dyspnea, and menstrual disturbance etc. (Table 4.) There was no clear difference in the incidence of symptoms between toxic diffuse goiter and toxic adenomatous goiter, but there was clear difference between toxic multinodular goiter. 4) Considering of results of $^{125}IT_3$ resin uptake rate and serum $T_4$ level in toxic diffuse goiter, toxic adenomatous goiter and toxic multinodular goiter, $^{125}I\;T_3$ resin uptake rate was $49.15{\pm}9.94%$ (mean) and serum $T_4\;21.29{\pm}7.04ug/dl$ (mean) in toxic diffuse goiter. In toxic multinodular goiter, $^{125}I\;T_3$ resin uptake rate was $32.47{\pm}6.74%$ (mean) and serum $T_4$ level $11.03{\pm}5.0ug/dl$, and then there was clear difference in the results of $^{125}I\;T_3$ resin uptake rate and serum $T_4$ between toxic diffuse goiter and toxic multinodular goiter. The levels of $^{125}I\;T_3$ resin uptake rate and serum $T_4$ in toxic adenomatous goiter were $40.32{\pm}13.08%$ (mean), $15.47{\pm}8.25ug/dl$ (mean) respectively, so there was no clear difference between toxic diffuse goiter and toxic adenomatous goiter. 5) There was no significant differnece in length and width performed with thyroid scanning in toxic diffuse goiter, toxic adenomatous goiter, and toxic multinodular goiter.

• The Korean Journal of Nuclear Medicine
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• v.27 no.1
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• pp.59-64
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• 1993

To evaluate the usefulness and differences in diagnosing coronary artery disease (CAD) between men and women of intravenous dipyridamole $^{99m}Tc$-MIBI myocardial SPECT, we obtained $^{99m}Tc$-MIBI myocardial SPECT and compared with the findings of coronary angiographies. Ninety eight male and 37 female patients who underwent dipyridamole $^{99m}Tc$-MIBI myocardial imaging within one month of cardiac catheterization were studied. Scans were considered abnormal if perfusion defect was detected and the defect size was more than 12% for left anterior descending artery (LAD) and circumflex (LCX) and 8% for right coronary artery (RCA) territories. Lesions${\geqq}$50% luminal diameter narrowing were considered significant CAD. Overall sensitivity for detection of CAD was 94.3% in men and 96.4% in women; specificity was 70% in men and 52.6% in women (P=not significant, ns). Vessel-matched sensitivity was 75.3% in men and 72.7% in women (P=ns): specificity was 84.6% in men and 67.9% in women (P < 0.025). For individual coronary artery, the sensitivity in men and women was 87.7%, 81.8% for LAD; 78%, 83.3% for RCA and 52.2%, 46.7% for LCX (P=ns): the specificity was 80%, 40% for LAD (P<0.01), 82.5%, 68.4% for RCA, 88.9%, 86.4% for LCX (P=ns). The hemodynamic parameter after intravenous dipyridamole in men and women were significantly changed; the heart rate was increased and systolic, diastolic blood pressure was decreased. Adverse effects were reported in 58.8% of men and 72.7% in women (P=ns). The incidence of chest pain and headache were higher in women. There was no significant difference in the incidences of nausea, abdominal pain, dizziness, facial flushing, dyspnea. In conclusion, dipyridamole $^{99m}Tc$-MIBI myocardial SPECT is a safe, noninvasive test for evaluation of CAD. There was no gender difference to detect CAD, but more false-positive rate in women especially in the territory of LAD.

• Journal of Digital Convergence
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• v.11 no.3
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• pp.337-344
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• 2013

This research has been conducted to determine the effect that the visually handicapped's participation in an aerobic exercise program has on cardiorespiratory function and arterial pulse wave. The subjects of this research were 20 people who have a 1st degree visual impairment. They recognized the purpose of this research and agreed to take part in it. After receiving agreements from their guardians, we divided them into an exercise group of 10 and a comparison group of 10 at random. The exercise group conducted a 50-70%HRmax treadmill exercise for 60 minutes a day, five times a week, for 12 weeks, including warm up and warm down exercises. We then conducted a two-way repeated ANOVA, which regards the period of exercise and the two groups as independent variables. The follow-up verification for exercise periods according to each group was carried out with a paired t-test. The statistical significance level was p<.05. The following are the results of this research. First, the weight and body fat of the experiment group after exercise show a meaningful reduction compared to before the exercise program (p<.05).Second, the VO2max, HRmax, and VEmax of the experiment group after exercise show a meaningful increase compared to before the exercise program (p<.05). Third, the arterial pulse wave of the experiment group after exercise display a meaningful increase compared to before the exercise program (p<.05). Fourth, the systolic blood pressure of the experiment group after exercise does not show a meaningful reduction compared to before the exercise program (p>.05). These results prove that the visually handicapped's participation in an aerobic exercise program is effective in the improvement of their cardiorespiratory function, bloodstream circulation function and blood vessel function.