• Journal of Korean Neurosurgical Society
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• v.66 no.1
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• pp.6-11
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• 2023

Spinal cord injury (SCI) has a significant negative effect on the quality of life due to permanent neurologic damage and economic burden by continuous treatment and rehabilitation. However, determining the correct approach to ensure optimal clinical outcomes can be challenging and remains highly controversial. In particular, with the introduction of the concept of early decompression in brain pathology, the discussion of the timing of decompression in SCI has emerged. In addition to that, the concept of "time is spine" has been added recently, and the mortality and complications caused by SCI have been reduced by providing timely and professional treatment to patients. However, there are many difficulties in establishing international clinical guidelines for the timing of early decompression in SCI because policies for each country and medical institution differ according to the circumstances of medical infrastructure and economic conditions in the surgical treatment of SCI. Therefore, we aim to provide a current review of timing of early decompression in patient with SCI.

• Journal of Chest Surgery
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• v.23 no.4
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• pp.736-744
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• 1990

From Jan. 1985 to Sep. 1989, four hundred and ten patients were admitted to the department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine with a diagnosis of nonpenetrating chest trauma. The most common cause of injury were motor vehicle accidents(75.1%) with the prevalent age group being their forties. The four most common findings were rib fracture(83.4%), hemothorax(50.7%), pneumothorax(24.6%) and clavicle fracture(12.0%), Fifty piratory insufficiency and the ventilation time was correlated with 6 fators : 1) shock 2) endotracheal intubation or tracheostomy 3) hemothorax 4) clavicle fracture 5) flail chest 6) more than three combined injuries or combined head injury. Ventilatory care was also related with mortality and complications such as pneumonia sepsis and empyema thoracis(p<0.05). The most common organism of post-traumatic infection were Pseudomonas and Staphylococcus.

• Journal of Chest Surgery
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• v.22 no.4
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• pp.609-619
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• 1989

During aortic valve surgery, cardioplegic solution is delivered through direct cannulation of both coronary ostia. Since this approach may cause an intimal injury leading to acute dissection or late ostial stenosis, this study was undertaken to evaluate myocardial protective effect of retrograde perfusion of cardioplegia [RCSP <% RRAP] in 18 clinical cases, which were compared with antegrade perfusion of cardioplegia in 27 clinical cases. This study were investigated 1] cease and return of electromechanical activity after cardioplegia infusion 2] the myocardial temperature during operation 3] the aortic cross clamping time and total bypass time 4] frequency of DC shock for defibrillation 5] need for inotropic drugs after operation 6] electrocardiographic evidence of myocardial infarction or ventricular arrhythmia after operation 7] the enzymes activity during preoperative and postoperative period as an evaluation of myocardial ischemic injury and 8] operative mortality rate The combination of retrograde cardioplegia and topical cooling with ice slush yielded promptly hypothermia of myocardium and shorter aortic cross-clamping time compared with antegrade cardioplegia [P < 0.05]. The temperature of the interventricular septum was maintained below 20oC by continuous perfusion or intermittent perfusion of cold blood cardioplegia and other results were no statistically significant difference between the two methods [P >0.05]. This technique provides clear operative field and avoids some serious complications which are caused by coronary ostial cannulation. These results suggested that the retrograde perfusion of cardioplegia is a simple, safe, and effective means of myocardial protection during open heart surgery.

• Journal of Preventive Medicine and Public Health
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• v.55 no.2
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• pp.164-172
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• 2022

Objectives: We aimed to estimate the space-time distribution of the risk of suicide mortality in Iran from 2006 to 2016. Methods: In this repeated cross-sectional study, the age-standardized risk of suicide mortality from 2006 to 2016 was determined. To estimate the cumulative and temporal risk, the Besag, York, and Mollié and Bernardinelli models were used. Results: The relative risk of suicide mortality was greater than 1 in 43.0% of Iran's provinces (posterior probability >0.8; range, 0.46 to 3.93). The spatio-temporal model indicated a high risk of suicide in 36.7% of Iran's provinces. In addition, significant upward temporal trends in suicide risk were observed in the provinces of Tehran, Fars, Kermanshah, and Gilan. A significantly decreasing pattern of risk was observed for men (β, -0.013; 95% credible interval [CrI], -0.010 to -0.007), and a stable pattern of risk was observed for women (β, -0.001; 95% CrI, -0.010 to 0.007). A decreasing pattern of suicide risk was observed for those aged 15-29 years (β, -0.006; 95% CrI, -0.010 to -0.0001) and 30-49 years (β, -0.001; 95% CrI, -0.018 to -0.002). The risk was stable for those aged >50 years. Conclusions: The highest risk of suicide mortality was observed in Iran's northwestern provinces and among Kurdish women. Although a low risk of suicide mortality was observed in the provinces of Tehran, Fars, and Gilan, the risk in these provinces is increasing rapidly compared to other regions.

• Journal of Chest Surgery
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• v.39 no.2 s.259
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• pp.127-133
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• 2006

Background: In the studies of the distribution of time to death in trauma patients, the early deaths within several hours after injury were a large component of total trauma deaths. Due to the development of trauma system, overall mortality of trauma was decreased, but trauma is still the major cause of deaths. Material and Method: From January 1994 to December 2003, trauma patients who had been admitted and had expired at tertiary hospital were enrolled. There was a total of 400 cases, a retrospective study was done to determine the distribution of trauma mortality according to the part of the body that were severely injured part and compared the difference between early deaths within 6 hours and late deaths after 6 hours. We also analysed the risk factors of early deaths due to trauma. Result: In severe injury to the head and abdomen, the distribution of mortality was bimodal. But, in severe chest injuries, the distribution was log-shape and most early deaths were almost of trauma related. The average of GCS were 5.86$\pm$4.15 for the early deaths and 8.24$\pm$5.02 for the late deaths (p < 0.05). The AIS of thorax were 2.66$\pm$1.87 for the early deaths and 1.55$\pm$1.76 for late deaths. The risk factors for early mortality were non-EMS transportation (odds ratio 3.474), high AIS (odds ratio 1.491) and GCS (odds ratio 0.859). Conclusion: In trauma patients, the causes of early mortality were severe brain injury and massive hemorrhage. Also severe chest injuries were the major cause of the early deaths in truama. Early diagnosis of chest injury can frequently be missed in the acute trauma setting. Therefore, high index of suspicion, a careful examination, and aggressive surgical treatment are important in multiple trauma patients.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.166-171
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• 2012

Purpose: In patients with traumatic hemoperitoneum or pelvic bone fracture who underwent angiography and embolization, we want to find the prognostic factors related with mortality. Methods: Patients(333 patients) who visited our hospital with traumatic injury from March 2008 to April 2012 were included in this study. Only 37 patients with traumatic hemoperitoneum or pelvic bone fracture underwent angiography and embolization. A retrospective review was conducted, and Glasgow coma scale (GCS), Revised trauma score (RTS), Injury severity score (ISS), initial laboratory finding and time interval, the amount of transfusion from the arrival at the ER to the start of embolization, and the vital signs before and after procedure were checked. Stastical analysis was conducted using the Chi square and Mann-Whitney U test. Results: In univariate analysis, the amount of transfusion, the base deficit before procedure, the systolic blood pressure before and after the procedure, the GCS, the RTS and the ISS were significantly associated with prognosis. In the multivariate analysis, the ISS and the base deficit had significant association with prognosis. Of the 37 patients who underwent angiography and embolization, 31 patients needed not additional procedure (Group A) while the other 6 patients needed an additional procedure (Group B). After procedure, a statistically significant higher blood pressure was observed in Group A than in Group B. As to the difference in blood pressure before and after the procedure, a statistically significant decrease in systolic blood pressure was observed in Group B, but an increase was observed in Group A. Conclusion: In traumatic hemoperitoneum or pelvic bone fracture patients who underwent angiography and embolization, GCS, ISS, RTS, transfusion amount before the procedure, initial base deficit and systolic blood pressure were factors related to mortality. When patients who underwent angiography and embolization only were compared with patients who underwent re-embolization or additional procedure after the first embolization, an increase in systolic blood pressure after embolization was a prognostic factor for successful control of bleeding.

• Journal of Trauma and Injury
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• v.22 no.2
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• pp.193-198
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• 2009

Purpose: This study evaluated the characteristics and the prognosis of multiple intraabdominal solid organ injuries, including those to the liver, spleen, and kidney, after blunt trauma. Methods: From January 2001 to March 2009, 39 patients with multiple intraabdominal solid organ injuries, which had been confirmed by contrast-enhanced computed tomography after blunt trauma, were included in this retrospective study. The injury severity score (ISS), abbreviated injury scale (AIS), revised trauma score (RTS), American Association for the Surgery of Trauma (AAST) injury grade of solid organs, initial hemodynamic status, blood gas analysis, blood transfusion, and the mortality were the main outcome measurements. Results: Injured groups were classified into liver/kidney (n=17), liver/spleen (n=4), spleen/kidney (n=13), and liver/kidney/spleen (n=5) groups. Patients were older in the liver/kidney group than in the liver/kidney/spleen group (43 vs 18 years, p=0.023). The initial systolic blood pressures tended to be lower in the liver/kidney group than in the other groups (84 vs 105, 112, and 114 mmHg, p=0.087). The amounts of 24-hour packed RBC transfusion were 32 units in the liver/kidney group and 4 units in the liver/kidney/spleen group, but the difference was not statistically significant. Differences were found in neither the RTS, ISS, and AIS for head, chest, abdominal, and pelvic injuries nor the AAST injury grade for solid organ, but injuries to the chest were more severe in the liver/spleen group than in the spleen/kidney group (AIS 4.0 vs 2.8, p=0.028). Conservative treatment was the most frequent applied treatment in all groups. There were 6 mortalities : 3 due to hypovolemia, 2 to sepsis, and 1 to brain injury. Mortalities occurred only in the liver/kidney group. Conclusion: Patients who had intraabdominal solid organ injuries of the liver and the kidney simultaneously, tended to be transfused more at an early time after trauma, to have lower initial systolic blood pressures, and to have a higher mortality.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.75-82
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• 2010

Purpose: In Korea, trauma is the $3^{rd}$ most common cause of death. The trauma treatment system is divided into pre-hospital and hospital stages. Deaths occurring in the pre-hospital stage are 50% of the total death, and 20% of those are deaths that are preventable. Therefore, the purpose of our study is to calculate the preventable death rates caused by trauma in our current pre-hospital system, to analyze the appropriateness of the treatment of traumatized patients and to draw a conclusions about the problems we have. Methods: The study was done on traumatized patients who expired at the emergency department from January 1, 2005, to December 31, 2009, at the Korea University Medical Centers in Anam, Guro and Ansan. The data on the patients were reviewed retrospectively based on characteristics, conditions on admission and trauma severity. The patient's RTS (revised trauma score) and ISS (injury severity score) was calculated. Preventable death rate was calculated by TRISS (the trauma score-injury severity score). Results: A total of 168 patients were enrolled. All patients were intubated and underwent CPR. Of the total, 72% patients were male, and traffic accidents were the most common form of trauma (52.4%), falls being second (28.6%). Head injury, solitary or multiple, was the most common cause of death (55.4%). Thirty-eight (38, 22.6%) deaths were preventable. The 22.6% preventable death rate consisted of 15.5% potentially preventable and 7.1% definitely preventable deaths. Based on a logistic regression analysis, the relationship between the time intervals until transfusion and imaging and death was statistically significant in the hospital stage. In the pre-hospital stage, transit time from the site of the injury to the hospital showed a significant relationship with the mortality rate. Conclusion: One hundred sixty-eight (168) patients died of trauma at the 3 hospitals of Korea University Medical Center. The TRISS method was used to calculate the preventable death rate, with a result of 22.6%. The only factor that was significant related to the preventable death rate in the pre-hospital stage was the time from injury to hospital arrival, and the time intervals until transfusion and imaging were the two factors that showed significance in the hospital stage. Shortening the time of treatment in the field and transferring the patient to the hospital as quickly as possible is the most important life-saving step in the pre-hospital stage. In the hospital stage, the primary survey, resuscitation and diagnosis should proceed simultaneously.

• Korean Journal of Veterinary Research
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• v.48 no.1
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• pp.125-130
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• 2008

Mesenteric torsion was diagnosed in a 2-year-old, spayed female Miniature Schnauzer. The patient was presented with acute depression, vomiting, lethargy and hematochezia. On physical examination, severe dehydration, tachycardia, tachypnea, weak femoral pulse, delayed capillary refill time and pale mucous membrane were found and the dog was in shock. Radiography and ultrasonography revealed intestines distended with gas, ascites and the "C" shaped distended intestine. Medical treatments including fluid therapy, analgesics, antibiotics and lidocaine for reducing reperfusion injury were applied. And then, the mesenteric torsion was definitively diagnosed through exploratory laparotomy and intestinal resection and anastomosis were performed. The dog made an uneventful recovery and was free of clinical sign one week after surgery. Mesenteric torsion is an unusual and life-threatening disease in dogs. It has usually been described in the middle and large breed dogs, especially German Shepherds. However, the mesenteric torsion should be included in the differential diagnostic lists for acute abdomen even in small breed dog. The mortality rate of mesenteric torsion can be reduced through prompt diagnosis, proper preventive therapy for shock and reperfusion injury and emergency surgery.

• Journal of Trauma and Injury
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• v.34 no.3
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• pp.162-169
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• 2021

Purpose: For severe lung injuries or acute respiratory distress syndrome that occurs during critical care due to trauma, extracorporeal membrane oxygenation (ECMO) may be used as a salvage treatment. This study aimed to describe the experiences at a single center with the use of ECMO in trauma patients. Methods: We enrolled a total of 25 trauma patients who were treated with ECMO between January 2015 and December 2019 at a regional trauma center. We analyzed and compared patients' characteristics between survivors and non-survivors through a medical chart review. We also compared the characteristics of patients between direct and indirect lung injury groups. Results: The mean age of the 25 patients was 45.9±19.5 years, and 19 patients (76.0%) were male. The mean Injury Severity Score was 26.1±10.1. Ten patients (40.0%) had an Abbreviated Injury Scale (AIS) 3 score of 4, and six patients (24.0%) had an AIS 3 score of 5. There were 19 cases (76.6%) of direct lung injury. The mortality rate was 60.0% (n=15). Sixteen patients (64.0%) received a loading dose of heparin for the initiation of ECMO. There was no significant difference in heparin use between the survivors and non-survivors (70% in survivors vs. 60% in non-survivors, p=0.691). When comparing the direct and indirect lung injury groups, there were no significant differences in variables other than age and ECMO onset time. Conclusions: If more evidence is gathered, risk factors and indications will be identified and we expect that more trauma patients will receive appropriate treatment with ECMO.