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Traumatic Diaphragmatic Hernia: A Report of 5 Cases (외상성 횡경막 탈장: 5례 수술 보고)

  • 장순명
    • Journal of Chest Surgery
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    • v.7 no.2
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    • pp.163-168
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    • 1974
  • Five cases of traumatic diaphragmatic hernia were repaired in the Department of Thoracic Surgery, Seoul National University Hospital, during the period from 1967 to 1974. The first case, a 14-year aid girl, was diagnosed as diaphragmatic hernia during laparotomy because of jejunal perforation 3 days after traffic accident. Herniated stomach, transverse colon, spleen and left lobe of the liver were repositioned and the diaphragmatic rupture on left posterolateral portion was repaired with two layers of nonabsorbable sutures by transthoracic approach. The second case, a 26-year old man,was diagnosed immediately after traffic accident at a local clinic and transferred to this hospital 24 hours later. Herniated stomach, transverse colon and jejunum were repositioned amd diaphragmatic rupture,about 9 cm in length,from the posterolat.edge to the base of pericardium was sutured in two layers. The third case, a 26-year old man who had stab wound on the left lower lateral chest two years ago,was admitted with sudden abdominal pain and vomiting. Upper gastrointestinal series with barium meal revealed diaphragmatic hernia. The herniated stomach and transverse colon through the defect,about 3.5cm in diameter, at anterolateral portion on the left side,were repositioned and repaired with two layers of nonabsorbable sutures. The forth case, a 26-year old man, sustained blunt trauma to the chest by a roller and was transferred to the emergency room complaining of dyspnea 40 minutes after the accident. The diaphragmatic rupture extended from left midaxillary line to contralateral anterior axillary line,about 20cm long, at anterior portion of diaphragm, which was repaired with two layers, of nonabsorbable sutures. The fifth case, a 4-year old girl, had two separate diaphragmatic ruptures on both sides, which were caused by traffic accident. Immediate upper gastrointestinal series after injury showed herniated stomach, colon and spleen into left Chest cavity. Another small rupture with anterior edge of right lobe of the liver in chest cavity was noted. These were repaired with non-absorbable sutures via thoracotomy.

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Traumatic Diaphragmatic Hernia (외상성 횡경막 허니아)

  • Jang, Bong-Hyeon;Han, Seung-Se;Kim, Gyu-Tae
    • Journal of Chest Surgery
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    • v.20 no.4
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    • pp.839-846
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    • 1987
  • The records of 10 patients with traumatic diaphragmatic hernia seen from November 1977 through July 1987 were reviewed. All the patients had a transdiaphragmatic evisceration of abdominal contents into the thorax. We treated 7 male and 3 female patients ranging in age from 3 to 62 years. In 8 patients, diaphragmatic hernia followed blunt trauma and in 2 patients, stab wounds to the chest. The herniation occurred on the right side in 3 patients and on the left side in 7. All the patients sustained additional injuries: rib fractures [7 patients], additional limb, pelvic and vertebral fractures [6], closed head injury [2], lung laceration [1], liver laceration [1], renal contusion [1], ureteral rupture [1], and splenic rupture [1]. Organs herniated through the diaphragmatic rent included the omentum [6 patients], stomach [4], liver [4], colon [3], small intestine [1], and spleen [1]. For right-sided injuries, the liver was herniated in all 3 patients and the colon, in 1. in the initial or latent phase, dyspnea, diminished breath sounds, bowel sounds in the chest were noted in 4 patients, and in the obstructive phase, nausea, vomiting, and abdominal pain were found in all 3 patients. Two patients had a diagnostic chest radiograph with findings of bowel gas patterns, and an additional 8 had abnormal but nondiagnostic studies. Hemothorax, pleural effusion or abnormal diaphragmatic contour were common abnormal findings. Three patients were operated on during the initial or acute phase [immediately after injury], 4 patients were operated on during the latent or intermediate phase [3 to 210 days], and 3 patients were operated on during the obstructive phase [10 to 290 days]. Six patients underwent thoracotomy, 2 required thoracoabdominal incision, and 2 had combined thoracotomy and laparotomy. Primary suture was used to repair the diaphragmatic hernia in 9 cases. One patient required plastic repair by a Teflon felt. Empyema was the main complication in 2 patients. In 1 patient, the empyema was treated by closed thoracostomy and in 1, by decortication and open drainage. There were no deaths.

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Clinical Observations of the Chest Trauma (흉부 손상에 대한 임상적 고찰)

  • 최명석
    • Journal of Chest Surgery
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    • v.23 no.5
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    • pp.905-915
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    • 1990
  • A clinical evaluation was performed on 545 cases of the chest trauma those had been admitted and treated at the department of thoracic and cardiovascular surgery in Chosun University Hospital during the past 11 years 5 months period from January 1978 to may 1989. Obtained results were as follows: 1. The ratio of male to female was 3.9: 1 in male predominance, and the majority[66.6%] was distributed from 3rd to 5th decade. 2. Nonpenetrating chest trauma was more common than penetrating about 4.6 times, and the most common cause of the nonpenetrating injuries was traffic accident[241/448, 53.8%] and of the penetrating injuries was stab wound[88/97, 90.7%]. 3. Only 79 cases[14.5%] were arrived to our emergency room within one hour after trauma. 4. The most common lesion due to trauma among these admitted patients was rib fracture[390/545, 71.6%], and the others were lung contusion[217/545, 39.8%], hemothorax[35%], hemopneumothorax[19.6%], and pneumothorax[11.8%] et al in decreasing order. 5. The associated injuries those required special treatment of other departments were 223 cases and its distributions were bone fractures[178/545, 32.7%], head injury[5.3%], and abdominal injury[6.6%]. 6. The others, but interesting chest injuries were follows: sternum fracture[3.1%], diaphragm rupture[2.6%], myocardial laceration and rupture[2 cases], bronchial rupture and laceration[2 cases], and traumatic thymoma rupture[1 case]. 7. The incidence of flail chest was 5.8%a[26/448] in the nonpenetrating injury, and the causes were multiple rib fracture which was in rows more than 4 rib fracture[20 cases], and sternum fracture[6 cases]. 8. We could managed the most of the patient with conservative treatment[43.1%] or closed tube thoracostomy[52.7%], but required emergency open thoracotomy in 64 cases

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A study on the strength Change of Used Pipe Support (재사용 파이프서포트의 내력변화 연구)

  • Baek, Sin-Won;Choe, Sun-Ju
    • Journal of the Korea Construction Safety Engineering Association
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    • s.38
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    • pp.79-87
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    • 2006
  • Formwork is a temporary structure that supports its weight and that of freshly placed concrete as well as construction live loads. In constructions site, pipe supports are usually used as shores which are consisted of the stab formwork. The strength of a pipe support is decreasing as it is frequently being used at the construction site. Among the accidents and failures that occur during concrete construction, there are many formwork failures which usually happen at the time concrete is being placed. The objective of this study is to find out the strength change of used pipe support and unused pipe supports according to aging. In this study, 2857 pipe supports were prepared. Among these pipe supports, 2337 pipe supports were lent to the construction companies free of charge. 520 pipe supports were kept on the outside. Compressive strength was measured by knife edge test and plate test at each 3 month. Test results show that the strength of unused pipe supports as well as used pipe supports was decreasing according to age, use frequency and load carrier, and the strength of used pipe supports was lower than the strength of unused pipe supports at the same age. So, the strength of used pipe supports from 191 days to present day was not satisfied the specification of KSF 8001. In this study, the strength of pipe support according to age, use frequency and load carrier was predicted using SPSS 12.0. It was known that the strength of pipe support using for 5 years was reduced to 42.8%. According to these results, it shows that attention has to be paid to formwork design using used pipe supports. Therefore, the present study results will be able to provide a firm base to prevent formwork collapses.

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A Study on the Characteristics of the Make-up on Corpses Depending on the Cause of Death in the American Drama CSI (미국드라마 CSI 에 나타난 사인(死因)에 따른 상처분장의 특성 연구)

  • Kim, Yu-Kyoung;Oh, In-Young
    • Journal of the Korean Society of Costume
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    • v.60 no.2
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    • pp.99-113
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    • 2010
  • The corpse make-up depending on the cause of death shown in CSI is the only evidence to solve a case, and shows the characteristics of the unique make-up on the corpse, according to the causes of death. There are many types of death causes such as strangulation, manslaughter, assassination and shooting, of which the strangulation is caused by strangling the neck with the hands or using a weapon and has characteristics of showing other external wounds with purple spots appearing on the body after death. This is a presentation of the corpse with a face of white, and the purple spots bruised on the neck. Manslaughter shows deep wounds caused by a stab or laceration using a weapon, and the material feeling of the wound that makes new skin tissue, is realistically presented with make-up of gooey blood. Assassination can be thought as manslaughter in disguise as an accidental death, which the causes can be due to electrocution, suffocation from oxygen deficiency and from excessive monoxide. The make-up is presented by realistically showing the surrounding fragments of the bullet shell, the blood running down, the size of the hole in the body made from the bullet, and shows the broken skin tissues. The shape of the bullet wound can be presented differently based on the body part where the bullet penetrated into, and the part where the bullet shot out through.

Augmentation Rhinoplasty with Dermofat Graft & Fat Injection (진피지방이식과 지방주입에 의한 비융기수술)

  • Na, Dae-Seung;Jung, Seung-Won;Kook, Kwang-Sik;Lee, Yong-Hae
    • Archives of Plastic Surgery
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    • v.38 no.1
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    • pp.53-62
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    • 2011
  • Purpose: Even though Augmentation rhinoplasty is very popular surgical procedure, it is not easy to obtain ideal materials for augmentation. Many different synthetic materials are used but frequent complications are seen such as infection, extrusion, deform, and dislocation. Autologous tissues were used for augmentation rhinoplasty. We used dermofat graft and fat injection in augmentation rhinoplasty minimizing these problems. Methods: From 2006 to 2009, we used autologous tissues in augmentation rhinoplasty in 40 patients, 20 patients with dermofat graft and other 20 patients were treated with fat injection only. Dermofats were harvested from sacral area. gluteal fold, groin and preexisting scar tissue. Dermofats were inserted with small stab wound and fat tissues were injected as Coleman's technique. The patients were followed up 6 months to 5 years. Results: Most of the patients were satisfied in shape and height the nose. Early complications such as hematoma, infection and seroma were not found. Secondary fat injection was performed in 3 patients (15%) of dermofat graft group instead of 7 patients (35%) of fat injection only group. Conclusion: We obtained satisfactory results in augmentation rhinoplasty with dermofat graft and fat injection. Secondary fat injections were more often in fat injection group than dermofat graft group. Dermofat graft and fat injection could be another alternative technique for augmentation rhinoplasty and fat injection could be a secondary adjunctive treatment for undercorrection due to absorption.

Delayed Presentation of Traumatic Diaphragmatic Hernia (지연성 외상성 횡격막 탈장)

  • Hwang, Kyung-Hwan;Hwang, Eui-Do;Oh, Duk-Jin;Kim, Jae-Hak;Na, Myung-Hoon;You, Jae-Hyun;Lim, Sung-Pyoung;Lee, Young
    • Journal of Chest Surgery
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    • v.31 no.2
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    • pp.162-167
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    • 1998
  • Between January 1976 and March 1997, six patients with delayed presentation of traumatic diaphragmatic hernia occured among the 52 patients of traumatic diaphragm rupture, of whom four males and two females, five by blunt trauma and one by stab wound, one was right side and the rest were left side. In all patients, reduction of herniated organs was accomplished by thoracotomy or thoracotomy with extension to abdomen. Suspicion of the diaphragmatic ruture from the acute traumatic chest injured patient is important and we can use the videothoracoscopy for evaluation and treatment of the traumatic diaphragm rupture

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SCANNING ELECTRON MICROSCOPIC STUDY OF THE INFLUENCE OF SIALOADENECTOMY ON THE CALCIFICATION OF DENTIN IN RATS (타액선(唾液腺) 적출(摘出)이 상아질(象牙質) 형성(形成)에 미치는 영향(影響)에 관(關)한 주사(走査) 전자현미경적(電子顯微鏡的) 연구(硏究))

  • Lee, Young-Sik;Park, Sang-Jin;Min, Byung-Soon;Choi, Ho-Young
    • Restorative Dentistry and Endodontics
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    • v.14 no.1
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    • pp.57-70
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    • 1989
  • The purpose of this study was to investigate the effect of salivary gland on the calcification of dentin in rats. 80 Sprague-Dawley male rats that weighed approximately 120gm were used in this study. 5 rats among them were shared as controls. 75 rats received sialoadenectomy were divided into submaxillary adenectomy group, parotidectomy group, and submaxillary-parotid gland combined removal group. In experimental groups, 25 rats in each of the 3 groups were sacrificed at the following intervals; 3 days, 1, 2, 3 and 4 weeks. All animals were sacrificed by vascular perfusion with 10% formalin. The maxillary incisors including periapical tissues were removed and defatted in 20% KOH solution at $0^{\circ}C$ for 24 hours, and dehydrated with acetone. Each tooth specimen was attached on the stab for scanning electron microscopic study. Gold was coated on the each specimen in the thickness of 300${\AA}$ at D.C. 1400V, 6mA for 6 minutes with coating machine (Eiko IB-3). Inner dentinal surfaces of the specimens were observed with SEM (Hitachi S-450). The results were as follows, 1. Parotidectomy groups were found to be inhibited the formation of dentinal calcification compared to submaxillary adenectomy groups in the eady stages. 2. Combined removal of submaxillary and parotid gland was appeared to cause more severe inhibition effect on the dentinal calcification than that of each salivary gland separately. 3. Inhibition of the calcification and mineralization of dentin caused by sialoadenectomy was more extreme from 3 day to 2 weeks after beginning of the experiments. However it was tended to be normalized after that. 4. Salivary gland was responsible for alterations in calcification and mineralization of dentinal growth.

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Delayed Presentation of a Post-traumatic Mesenteric Arteriovenous Fistula: A Case Report (외상 후 지연성으로 발생한 장간막 동정맥루: 증례보고)

  • Cho, Jayun;Jung, Heekyung;Kim, Hyung-Kee;Lim, Kyoung Hoon;Chun, Jae Min;Huh, Seung;Park, Jinyoung
    • Journal of Trauma and Injury
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    • v.26 no.3
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    • pp.248-251
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    • 2013
  • Introduction: A post-traumatic mesenteric arteriovenous fistula (AVF) is extremely rare. Case Report: A previously healthy 26-year-old male was injured with an abdominal stab wound. Computed tomography (CT) showed liver injury, pancreas injury and a retropancreatic hematoma. We performed the hemostasis of the bleeding due to the liver injury, a distal pancreatectomy with splenectomy and evacuation of the retropancreatic hematoma. On the 5th postoperative day, an abdominal bruit and thrill was detected. CT and angiography showed an AVF between the superior mesenteric artery (SMA) and the inferior mesenteric vein with early enhancement of the portal vein (PV). The point of the AVF was about 4 cm from the SMA's orifice. After an emergent laparotomy and inframesocolic approach, the isolation of the SMA was performed by dissection and ligation of adjacent mesenteric tissues which was about 6 cm length from the nearby SMA orifice, preserving the major side branches of the SMA, because the exact point of the AVF could not be identified despite the shunt flow in the PV being audible during an intraoperative hand-held Doppler-shift measurement. After that, the shunt flow could not be detected by using an intraoperative hand-held Doppler-shift measuring device. CT two and a half months later showed no AVF. There were no major complications during a 19-month follow-up period. Conclusion: Early management of a post-traumatic mesenteric AVF is essential to avoid complications such as hemorrhage, congestive heart failure and portal hypertension.

A Modified McIndoe Operation for Treatment of Vaginal Agenesis (개량된 McIndoe 술식을 이용한 무질증 환자의 질 재건)

  • Tark, Kwan Chul;Choi, Bong Kyoon;Choi, Jong Woo
    • Archives of Plastic Surgery
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    • v.32 no.1
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    • pp.117-123
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    • 2005
  • The reconstructive modalities for vaginal reconstruction include simple dilatation, skin graft, use of intestinal segments and various methods using flaps. However, skin grafting procedure is the most commonly used technique and the McIndoe procedure is a representative technique among skin grafting procedures. McIndoe procedure is easier, faster and has a lower morbidity compared to other techniques. However the conventional McIndoe procedure has several problems such as incomplete vestibule formation, excessive bleeding during dissection, possibility of recto-vaginal or urethro-vaginal fistula formation, late vaginal contracture and discomfort in wearing hard plastic mold for a long time after operation. To solve these problems, the authors modified the conventional McIndoe procedure in several perspectives. The undeveloped vestibule was incised with X-shaped mucosal incision between the urethral opening and posterior margin of the vestibule and deepened by blunt finger dissection to provide a sufficient diameter & length of the neovagina and to minimize bleeding. A sizable medium thickness split skin graft was harvested and wrapped over a roll gauze-filled condom mold. Applying multiple stab incision on the skin grafted condom mold, it was inserted into the prepared neovaginal canal. Distal margin of the skin graft was secured with tips of the mucosal flaps created by X-shaped vestibular incision to prevent accidental extrusion of the skin grafted mold. During last 15 years, we applied this modification to 20 vaginal agenesis patients and investigated results of the 12 patients who could be followed up serially including hematoma formation and skin graft survival rate, size, depth, presence of late contracture, appearance, comfortness, and hygiene of the neovagina. And they were compared with 8 patients of 20 patients who underwent conventional McIndoe procedures. The modified McIndoe procedure revealed lower complication rate, higher patient satisfaction and better functional results.