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Management of gunshot wounds near the elbow: experiences at a high-volume level I trauma center

  • Umar Ghilzai;Abdullah Ghali;Aaron Singh;Thomas Wesley Mitchell;Scott A. Mitchell
    • Clinics in Shoulder and Elbow
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    • v.27 no.1
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    • pp.3-10
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    • 2024
  • Background: Gunshot-related fractures near the elbow are challenging, and available data to guide the practitioner are lacking. This report analyzes injury patterns and treatment strategies in a case series from a high-volume urban trauma center. Methods: All periarticular gunshot fractures near the elbow treated at a level 1 trauma center from 2014 to 2018 were retrospectively reviewed. Fracture location, patient demographics, concomitant injuries, treatment modalities, and complications were analyzed. Results: Twenty-four patients were identified. All patients received prophylactic antibiotics upon admission and underwent urgent surgical debridement. Open reduction and internal fixation (ORIF) was performed with initial debridement in 22 of 24 patients. Seven patients sustained distal humerus fractures, 10 patients sustained isolated proximal ulna or proximal radius fractures, and seven had combined fracture patterns. Eleven patients presented with nerve palsy, and two had transected nerves. Two patients had vascular injury requiring repair. One patient required a temporary elbow-spanning external fixator and underwent staged debridement followed by ORIF. One patient with a grade IIIC fracture developed a deep infection that precluded ORIF. One patient required revision ORIF due to fracture displacement. Conclusions: This investigation reports on management of ballistic fractures near the elbow at a busy urban level I trauma center. Our management centered on rapid debridement, early definitive fixation, and intravenous antibiotic administration. We report on associated neurovascular injury, bone loss, and other challenges in this patient population. Level of evidence: IV.

Effect of Hwanggeumjackyak-tang (HJT) on the DSS-induced ulcerative colitis mouse model : including changes in intestinal metabolites (황금작약탕이 DSS로 유발된 궤양성 대장염 생쥐 모델에 미치는 영향 : 장내 대사물질 변화를 포함하여)

  • Cha-Kyung Youn;Sang-Mi Kang;Seon-Ah Son;Yang-Hee You;Eun-Ju Kim;Hong-Seok Son;Jae-Uk Sul;Chang-Su Na
    • Herbal Formula Science
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    • v.31 no.4
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    • pp.341-360
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    • 2023
  • Background : To investigate the effect of Hwanggeumjackyak-tang (HJT) on Dextran sulfate sodium (DSS) induced ulcerative colitis. Methods : The experimental animals were divided into three groups; group 1, normal group(Normal); group 2, DSS-induced colitis and untreated group(UT+DSS); group 3, DSS-induced colitis and HJT 200 mg-treated group(HJT200+DSS). We evaluated cytotoxicity after HJT administration and confirmed the anti-inflammatory effect by histological changes in the intestine and genetic analysis of mucosal cells after HJT administration for each group. In addition, microbiological weapons and metabolites in faeces were examined, and the correlation between gut microbiome and metabolites was also investigated. Result : HJT was not observed to be cytotoxic, even at relatively high concentrations, and was effective in protecting the barrier and preventing intestinal inflammation by suppressing the increase in mucus secretion and the expression of inflammatory factors in mucosal cells. HJT treatment affected the increase in the amount and diversity of the gut microbiome in faeces and the increase in metabolites thought to be involved in alleviating inflammation in the gut. Conclusion : This study demonstrates the therapeutic potential of HJT in ulcerative colitis. Further studies should be carried out to confirm our findings.

Assessment of Hydroureteronephrosis in Children Using Diuretic Radionuclide Ureterography (동위원소 이뇨 요관그람을 이용한 소아 요관폐쇄의 평가)

  • Kim, Jong-Ho;Lee, Dong-Soo;Kwark, Cheol-Eun;Lee, Kyung-Han;Choi, Chang-Woon;Chung, June-Key;Lee, Myung-Chul;Koh, Chang-Soon;Choi, Yong;Choi, Hwang
    • The Korean Journal of Nuclear Medicine
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    • v.28 no.1
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    • pp.75-84
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    • 1994
  • The need for assessment of ureteric function in the patient with an obviousely dilated ureter has increased particularly with the added spectrum of asymptomatic patients presenting with hydrone-phrosis and hydroureter on antenatal and perinatal ultrasound. To assess the influence of ureteral status on kidney washout during $^{99m}Tc$-DTPA diuretic renography, ureteral images were reviewed in 80 children referred for hydronephrosis. A scintigraphically abnormal ureter was defined as an intense and continuous image of > 10 min during diuretic renography. Out of them, a total of 16 nephroureteral systems in 12 children with scintigraphically abnormal ureter were analyzed. A diuretic washout index using response half time (t1/2) by linear fitting after lasix injection, was determined on renal (Kt1/2) and ureteral (Ut1/2) curves (diuretic renogram vs. diuretic ureterogram). Diuretic ureterogram curve patterns corresponding to normal (type I), obstructive (II) and non-obstructive (III) cases were described. Compared with X-ray data, diuretic renography was highly sensitive (88%) and specific (99%) for detecting any ureteral abnormality. Despite an obstructive Kt1/2 (>20 min), no patient with an abnormal ureter underwent therapy at the ureteropelvic junction because the hydronephrosis regressed after surgery at the lower level. Our data indicate that the abnormal ureter findings during diuretic renography have to be recognized before therapy for children with hydeonephrosis.

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A STUDY ON TEMPERATURE VARIATION OF THE UPPER THERMOSPHERE IN THE HIGH LATITUDE THROUGH THE ANALYSIS OF 6300 $\AA$ AIRGLOW DATA (6300 $\AA$ 대기광 자료 분석을 통한 고위도 열권 상부에서의 온도 변화)

  • 정종균;김용하;원영인;이방용
    • Journal of Astronomy and Space Sciences
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    • v.14 no.1
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    • pp.94-108
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    • 1997
  • The temperature of the upper thermosphere is generally varied with the solar activity, and largely with geomagnetic activity in the high latitude. The data analyzed in this study are acquired at two ground stations, Thule Air Base($76,5{deg} N, 68.4{deg} W, A = 86{deg}$) and $S{psi}ndre Str{psi}mfjord (67.0{deg} N, 50.9{deg} W, A = 74{deg}$), Greenland. Both stations are located in the high latitude not only geographically but also geomagnetically. The terrestrial night glow at 6300 ${angs}$ from atomic oxygen has been observed from the two ground-based Fabry-Perot interferometers, during periods of 1986~1991 in Thule Air Base and 1986~1994 in $S{psi}ndre Str{psi}mfjord$. Some features noted in this study are as follows: (1) The correlation between the solar activity and the measured thermospheric temperature is highest in the case of $3{leq}Kp{leq}4$ in Thule, and increases with the geomagnetic activity in $S{psi}ndre Str{psi}mfjord$. (2) The measured temperatures at Thule is generally higher than those at $S{psi}ndre Str{psi}mfjord$, but the latter shows steeper slope with the solar activity. (3) The harmonic analysis shows that the diurnal variation(24hrs) is the main feature of the daily temperature variation with a temperature peak at about 13-14 LT (LT=UT-4). However, the semi-diurnal variation is evident during the period of weak solar activity. (4) Generally the predicted temperatures from both MSIS86 and VSH models are lower than the measured temperature, and this discrepancy grows as the solar activity increases. Therefore, we urge modelers to develope a new thermospheric model utilizing broader sets of measurements, especially for high solar activity.

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Water Physiology of Panax ginseng. 1. Habitat observation. cultural experience, weather factors and characteristics of root and leaf (인삼의 수분생리 1. 자생지관찰.재배 경험.기상요인과 근 및 엽의 특성)

  • Park, Hoon
    • Journal of Ginseng Research
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    • v.4 no.2
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    • pp.197-221
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    • 1980
  • Habitat observation, cultural experience of old and present plantation, weather factors in relation to crop stand and water physiology of root and leaf were reviewed. According to habitat observation ginseng plants love water but plate wit talus well grow at drained place with high moisture content in air and soil while ginseng plants were not found in dry or wet place. According to cultivation experience ginseng plants require abundant water in nursery and main field but most old planters believe that ginseng plaints are draught-loving thus require little water. The experience that rain especially in summer i.e unfavorable might be due to mechanical damage of leaves arid leaf disease infection, or severe leaf fall which is caused by high air temperature and coinsided with rain. According to crop stand observation in relation to weather factors abunsant water increased each root weight but decreased total yield indicating tile increase of missing root rate. Rain in summer was unfavorable too. Though rain in June was favorable for high yield general experience that cloudy day and rain were unfavorable might be due to low light intensity under shade. Present leading planters also do loot consider the importance of water in main field. Water content is higher in top than in root and highest in central portion of root and in stem of top. For seedling the heavier the weight of root is tile higher the water content while it reveries from two years old. Water potential of intact root appeared to be -2.89 bar suggesting high sensitivity to water environment. Under water stress water content severly decreased only in leaf. Water content of leaf appeared to be 78% for optimum, below 72% for functional damage and 68% for perm anent wilting. Transpiration or curs Principally through stomata in lower side of leaf thus contribution of upper side transpiration decreased with the increase of intensity. Transpiration is greater in the leaves grown under high light intensity. Thus water content is lower with high light inte nsity under field condition indicating that light is probable cause of water stress in field. Transpiration reached maximum at 10K1ut The decrease of transpiration at higher temperature seems to be due to the decrease of stomata aperture caused by water stress. Severe decrease of photosynthesis under water stress seems to be principally due to functional damage which is not caused by high temperature and Partly due to poor CO2 supply. Water potential of leaf appeared to be -16.8 bar suggesting weakness in draught tolerance. Ginseng leaves absorb water under high humidity. Water free space of leaf disc is %mailer than that of soybean leaf and water uptake appears to be more than two steps.

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UBVRI CCD PHOTOMETRY OF THE TYPE Ic SUPERNOVA SN 1994I IN M51: THE FIRST TWO MONTHS

  • LEE MYUNG GYOON;KIM EUNHYEUK;KIM SANG CHUL;KIM SEUNG LEE;PARK WON KEE;PYO TAE SOO
    • Journal of The Korean Astronomical Society
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    • v.28 no.1
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    • pp.31-43
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    • 1995
  • We present UBVRI CCD photometry of the Type Ie supernova SN 19941 in M51 which was discovered on April 2, 1994 (UT). UBVRI CCD photometry of SN 1994 I were obtained for the period of the first two months from April 4, 1994, using the Seoul National University Observatory 60 cm telescope. The light curves of SN 19941 show several interesting features: (a) SN 19941 reaches the maximum brightness at B-band on April 8.23 (B = 13.68 mag), at V-band on April 9.10 (V = 12.89 mag), and at I-band on April 10.32 (I = 12.48 mag); (b) The light curves around the maximum brightness are much narrower than those of other types of supernovae; (c) The light curves after the peak decline more steeply than those of other types of supernovae; and (d) The colors get redder from $(V-R){\approx}0.2 mag ((V - I){\approx} 0.3 mag, (B - V){\approx}0.7 mag)$ on April 4 to $(V-R){\approx}0.6 mag ((V-1){\approx}0.9 mag, (B-V){\approx}1.3 mag)$ on April 18. Afterwards (V - R) colors get bluer slightly $(by\~0.005 mag/day)$, while (V-I) colors stay almost constant around $(V-1){\approx}1.0 mag$. The color at the maximum brightness is (B-V)=0.9 mag, which is $\~1$mag redder than the mean color of typical Type la supernovae at the maximum brightness. The light curves of SN 1994I are similar to those of the Type Ie supernova SN 1962L in NGC 1073. Adopting the distance modulus of $(m-M)_0 = 29.2 mag$ and the reddening of E(B - V) = 0.45 mag [Iwamoto et al. 1994, preprint for ApJ], we derive absolute magnitudes at the maximum brightness of SN 1994I, Mv(max) = -17.7 mag and MB(max) = -17.4 mag. This result shows that SN 1994I was $\~2$mag fainter at the maximum brightness compared with typical Type Ia supernovae. A narrower peak and faster decline after the maximum in the light curve of SN 1994I compared with other types of supernovae indicate that the progenitor of SN 1994I might be a lower mass star compared with those of other types of supernovae.

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Study on the Micro Crack Detection in Joints by Using Ultrasound Infrared Thermography (초음파 적외선 열화상을 이용한 접합부의 미세균열 검출 연구)

  • Park, Hee-Sang;Choi, Man-Yong;Park, Jeong-Hak;Lee, Seung-Seok;Huh, Yong-Hak;Lee, Bo-Young;Kim, Jae-Seong
    • Journal of the Korean Society for Nondestructive Testing
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    • v.32 no.2
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    • pp.162-169
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    • 2012
  • This study detected SCC defects of dissimilar metal welded(STS304 and SA106 Gr. b) pipes using the ultrasonic infrared thermography method and the lock-in image treatment method among infrared thermography method. The infrared excitement equipment has 250 Watt of output and 20 kHz of frequency. By using the ultrasound infrared thermography method, the internal defects of dissimilar metal weld joints of pipes used at nuclear power plants could get detected. By an actual PT test, it was observed that the cracks inside the pipe existed not as a single crack but rather as a multiple cracks within a certain area and generated a hot spot image of a broad area on the thermography image. In addition, UT technology could not easily defects detected by the width of $10\;{\mu}m$ fine hair cracks. but, ultrasound infrared thermography technique was defect detected.

Effects of Particle Size of Fly Ash on the High Strength of Hardened Cement Mortar (시멘트 모르터 경화체의 고강도화에 미치는 플라이 애쉬 입자크기의 영향)

  • 김영수;김정환
    • Magazine of the Korea Concrete Institute
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    • v.6 no.5
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    • pp.131-139
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    • 1994
  • The min aim of thls study was to evaluate the effect of particle slze of the fly ash as a cement additive. Experimental work was carried out with three different sizes of fly ash. 18.58, 8.95 and 4.02{$mu}m$ in average radius. Namely, the effect of particle size variation of fly ash on the physical properties of cement paste was investigated. The jluidity was decreased with increasing the addition of fly ash to cement paste regardless of the particle size variation. The decrement of the fluidity of the pulverized fly ash was higher than that of the spherical fly ash. On the other hand, the pozzolan reactivity increased with lowering particle size. In the case of specimens with 5% up to 10% addition of fly ash having a particle size of 4.02{$mu}m$. the compressive strength was increased as compared with the plain specimens before curing for 28 days and showed higher value above 800kg /$cm^2$ when cured for 60 days.This increased compressive strength was ascribed to both the closer packlng of fine particles and the pozzolan reactivity of fly ash. These results were comfirmed by measuring both the porosity of the specimens and Ca(OH ), contents remained in specimens. This work showed that could be effectively ut~lized as a blending material without any de crease in the strength of early hydration stage if we can control the particle size of fly ashes by sizing or pulverizing.

The Effect of Cheonmagudeng-um gagam(CGG) on Spontaneous Hypertensive Rat(SHR) (천마구등음가감(天麻鉤藤飮加減)이 고혈압 유관인자 및 SHR 병태모델에 미치는 영향)

  • Song, Byoung-Yong;Choi, Eun-Hee;Jung, Tae-San;Kang, Seong-Sun;An, Ga-Yong;Kim, Oh-Young;Jeon, Sang-Yun;Hong, Seok
    • The Journal of Internal Korean Medicine
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    • v.32 no.3
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    • pp.345-360
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    • 2011
  • Objectives : This study was examined to investigate the effects of Cheonmagudeng-um gagam (CGG) extract on spontaneous hypertension. Methods : For the study of CGG, we divided rats into three groups. The normal group was Wister Kyoto rats (WKY). The control group was spontaneously hypertensive rats (SHR). The treatment group was SHR which were administered CGG extract (SHR-CGG). SHR-CGG were orally administered CGG extract that was diluted in distilled water at the various concentrations for 4 weeks (234.5 mg/kg) and SHR were orally administered the same dosage of plain distilled water as SHR-CGG. Then we measured anti-oxygen effects, ACE inhibitory activity, weight of heart and kidney, blood pressure, heart rate, plasma aldosterone, electrolyte, creatinine, uric acid, BUN, and observed the cortex of the cardiac muscle, kidney, and adrenal gland. Results : CGG increased DPPH scavenging activity and SOD similar activity depending on the concentration. CGG significantly decreased ROS, TNF-${\alpha}$, IL-6, IL-$1{\beta}$, heart weight, blood pressure, heart rate, aldosterone, and BUN in SHR. CGG increased ACE inhibition activity depending on the concentration. CGG inhibited the heart, kidney and adrenal gland tissue injury that is caused by hypertension. Conclusions : These results suggest that CGG is effective in treatment and prevention of hypertension.

A Study on Suppression of UT Grain Noise Using SSP MPO Algorithms (SSP MPO 알고리즘을 이용한 초음파 결정립 잡음 억제에 관한 연구)

  • Koo, Kil-Mo;Jun, Kye-Suk
    • The Journal of the Acoustical Society of Korea
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    • v.15 no.6
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    • pp.81-89
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    • 1996
  • It is very important for ultrasonic test method to evaluate the integrity of the class I components in nuclear power plants. However, as the rltrasonic test is affected by internal structures and configurations of test materials, backscattering, that is, time invariant noise is generated in large grain size materials. Due to the above reason, the received signal results in low signal to noise(S/N) ratio. Split spectrum processing(SSP) technique is effective to suppress the grain noise. The conventional SSP technique. however, has been applied to unique algorithm. This paper shows that MPO(minimization and polarity threshold) algorithm which two algorithms are applied simulatancously, was utilized, the signal processing time was shorten by using the new constant-Q SSP with the FIR filter which frequency to bandwidth ratio is constant and the optimum parameters were analysed for the signal processing to longitudinal wave and shear wave with the same requirements of inspection on nuclear power plant site. Moreover, the new ultrasonic test instrument, the reference block of the same product form and material specification, stainless stell test specimens and copper test specimens block of the same fabricated for the application of new SSP technique. As the result of experimental test with new ultrasonic test instrument and test specimens, the signal to noise ratio was improved by appying the new SSP technique.

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