• Journal of Korean Neurosurgical Society
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• 제65권3호
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• pp.385-396
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• 2022

Abusive head trauma (AHT) in infants, especially acute subdural hematoma, has an extremely poor outcome. The most decisive and important finding is the appearance of a widespread low-density area on head computed tomography. This phenomenon was traditionally thought to be caused by cerebral ischemia. However, many other pathophysiological abnormalities have been found to be intricately involved. Recent studies have found that status epilepticus and hyperperfusion injures are the major causes. Another serious problem associated with AHT is cardiopulmonary arrest (CPA). Many infants are reported to visit to the hospital with CPA, and its pathophysiology has not been fully elucidated. This paper examines the background of these pathological conditions and associated factors and elucidate the pathophysiological mechanisms resulting in poor outcomes in AHT. In addition to the intensity of assault on the head, the peculiar pathophysiological characteristics in infants, as well as the social background specific to child abuse, are found to be associated with poor outcome.

• Journal of Korean Neurosurgical Society
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• 제59권5호
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• pp.529-532
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• 2016

Complex regional pain syndrome (CRPS) type II is a syndrome that develops after nerve injury. Symptoms may be severe, and vary depending on the degree of sympathetic nerve involvement. As yet, there is no satisfactory treatment. We report the case of a female patient who had an L5 left transverse process fracture and an S2 body fracture, who developed symptoms of CRPS type II in her left lower leg that were aggravated during ambulation in spite of absolute bed rest for one month after the trauma. Several treatments, including bed rest, medication, and numerous nerve blocks were attempted, but the pain persisted. We finally tried injection of polydeoxyribonucleotide (PDRN) solution at the left L5 transverse process fracture site because we knew of the anti-inflammatory effect of PDRN. One day after this treatment, her symptoms had almost disappeared and three days later, she was discharged. We will also further discuss the possibility of using PDRN solution for the treatment of CRPS.

• Archives of Plastic Surgery
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• 제32권6호
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• pp.706-709
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• 2005

The absence of the nipple-areolar complex(NAC) in men are seldom stated, as a result of trauma, burn, mastectomy, or after the correction of extreme bilateral gynecomastia. A total of 50 healthy men aged 21 to 27 years were examined. We recorded the configuration (dimensions and shape) and the location of the NAC with respect to fixed skeletal anatomic landmarks. Of the 50 subjects examined, 44 had oval and 6 had a round NAC. The mean diameter for a round NAC was 24.3 mm. The center of the NAC was in the fourth intercostal space in 41 volunteers and in the fifth intercostal space in 9 of the subjects. To localize the NAC on the chest wall, at least three reproducible measurements proved to be necessary, composed of a horizontal line(distance from the midsternal line to the nipple, A), a medial oblique line(distance from the sternal notch to the nipple, B) and a lateral oblique line(distance from the acromioclavicular joint to the nipple, C). Using these three parameters, we recommend that the appropriate location can be calculated derived from the circumference of the chest.

• Annals of Clinical Neurophysiology
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• 제24권2호
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• pp.35-45
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• 2022

Complex regional pain syndrome (CRPS) is a chronic regional pain disorder that most frequently affects the limbs. It is characterized by hyperalgesia, allodynia, edema, motor disturbance, and vasomotor instability, and typically occurs following surgery or trauma. In type-I CRPS there is no confirmed nerve injury, while peripheral nerve injury is present in type-II CRPS. The multifactorial pathophysiological etiology of CRPS includes inflammation, autoimmune responses, abnormal cytokine production, autonomic dysfunction, altered blood flow, psychological factors, and central cortical reorganization. There are no specific laboratory diagnostic tools for CRPS, and so it is diagnosed clinically. The Budapest criteria are currently the most-accepted diagnostic criteria.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제13권1호
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• pp.15-23
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• 2002

소아기 외상이 아동의 발달에 미치는 부정적인 결과를 예방하는 resilience factor와 부정적인 결과를 더욱 증폭시키는 위험인자에 대한 지식은 이 분야의 전향적인 연구의 부재와 소아기 외상과 발달과정, 아동의 환경 등 다양한 측면들의 유기적인 관계에 대한 이해의 어려움으로 아직은 초보적인 단계이다. 이러한 소아기 외상의 연구에서의 개념적, 연구 방법론적인 어려움은 현재까지 발표된 연구들의 결과가 일관적이지 못하고 때로는 상반적이기도 한 면으로 나타나기도 한다. 이러한 어려움에도 불구하고 지금까지 발표된 연구들을 종합하여 보면 몇 가지 중요한 공통적인 결론을 도출할 수가 있다. 즉 사춘기 전에는 여아가, 사춘기 후나 영아에서는 남아가, 사회경제적 지위가 높은 가정의 아동, 기질적인 문제가 없는 경우, 쉬운 기질, 조기 이별이나 상실의 경험이 없는 경우, 외상을 받은 시기가 어릴수록, 문제 해결능력이 좋은 경우, 높은 자존감, internal locus of control, 우수한 대처 능력, 대인 관계를 인지 할 수 있는 능력, 놀이를 할 수 있는 능력, 유머 감각이 있는 경우, 유능한 부모를 가지고 있거나 혹은 적어도 한명의 보호자와 따뜻한 관계를 맺고 있을 때, 교육 정도가 높거나 조직적인 종교 활동에 참여 하고 있는 아동들은 외상을 경험하였을 때 외상의 부정적인 결과에 대하여 resilient하게 된다. 이러한 결과는 아동기 외상의 위험 및 보호인자가 서로 독립되어 있기 보다는 상호작용을 하는 유기적인 관계이며, 각 요소가 아동의 발달 단계, 아동 자신 및 그들의 가족과 환경에 따라 다양하게 작용하고, stressor의 영향은 그 강도에 따라 다양한 작용을 보이며 일부 위험요소와 보호요소는 상대방의 효과를 상승시키거나 감소시키는 등 복잡한 상호 관계를 보이는 것을 시사한다. 앞으로 소아기 외상과 발달 정신병리와의 관계, 위험 및 보호인자에 대한 포괄적인 이해 및 이를 바탕으로 효과적이며 효율적인 예방 및 치료적인 개입이 가능해지기 위해서는 stress가 정상적인 신경발달에 미치는 영향, 유전적인 소인과 부모의 요인과 같은 개개인의 소인에 대한 차이점, 신경조절의 resilience 연구, 소아기 외상의 예방과 뇌의 plasticity에 관한 연구가 같이 진행되어야 할 것이다.

• Archives of Plastic Surgery
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• 제49권1호
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• pp.91-98
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• 2022

Background Predicting the need for post-traumatic reconstruction of lower extremity injuries remains a challenge. Due to the larger volume of cases in adults than in children, the majority of the medical literature has focused on adult lower extremity reconstruction. This study evaluates predictive risk factors associated with the need for free flap reconstruction in pediatric patients following lower extremity trauma. Methods An IRB-approved retrospective chart analysis over a 5-year period (January 1, 2012 to December 31, 2017) was performed, including all pediatric patients (<18 years old) diagnosed with one or more lower extremity wounds. Patient demographics, trauma information, and operative information were reviewed. The statistical analysis consisted of univariate and multivariate regression models to identify predictor variables associated with free flap reconstruction. Results In total, 1,821 patients were identified who fit our search criteria, of whom 41 patients (2.25%) required free flap reconstruction, 65 patients (3.57%) required local flap reconstruction, and 19 patients (1.04%) required skin graft reconstruction. We determined that older age (odds ratio [OR], 1.134; P =0.002), all-terrain vehicle accidents (OR, 6.698; P<0.001), and trauma team activation (OR, 2.443; P=0.034) were associated with the need for free flap reconstruction following lower extremity trauma in our pediatric population. Conclusions Our study demonstrates a higher likelihood of free flap reconstruction in older pediatric patients, those involved in all-terrain vehicle accidents, and cases involving activation of the trauma team. This information can be implemented to help develop an early risk calculator that defines the need for complex lower extremity reconstruction in the pediatric population.

• Journal of Korean Biological Nursing Science
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• 제23권4호
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• pp.257-266
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• 2021

Purpose: The purpose of this study was to analyze the content of nursing interventions applied to patients with thoracic injury who visited a trauma emergency room (TER) or an emergency room (ER). Methods: Of 3,938 trauma patients admitted to this hospital between January 1, 2019 and December 31, 2020, 320 adult patients with thoracic injury (94 to TER, 226 to ER) who met the inclusion criteria were enrolled. Patients' data were acquired from their electronic medical records. General and clinical characteristics of these subjects along with nursing interventions were analyzed. Results: There were statistically significant differences in the length of stay, treatment outcome, and level of consciousness between thoracic injury patients who visited TER and ER. Average thoracic Abbreviated Injury Scale score and average Injury Severity Score of thoracic injury patients who visited TER were 3.13 and 13.54, respectively, which were significantly higher than those of patients who visited ER. The numbers of nursing actions applied was 4,819 for TER and 3,944 for ER, which were classified into five domains, 18 classes, and 56 interventions. The most domain of interventions carried out in both TER and ER was physiological: complex. Classes including Crisis management and Thermoregulation were not carried out in ER. On average, 16 more types of interventions were carried out in TER than in ER. Conclusion: This study demonstrated characteristics of thoracic injury patients and nursing interventions by emergency room type. Based on results of this study, standardized nursing interventions need be applied to thoracic injury patients visiting TER and ER.

• Clinics in Shoulder and Elbow
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• 제25권3호
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• pp.210-216
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• 2022

Background: Reverse shoulder arthroplasty (RSA), first introduced as a management option for cuff tear arthropathy, is now an accepted treatment for complex proximal humeral fractures. Few studies have identified whether the outcomes of RSA for shoulder trauma are comparable to those of RSA for shoulder arthritis. Methods: This is a retrospective, single-institution cohort study of all patients who underwent RSA at our institution between January 2013 and December 2019. In total, 49 patients met the inclusion criteria. As outcomes, we evaluated the 1-year American Shoulder and Elbow Surgeons (ASES) and Constant shoulder scores, postoperative shoulder range of motion, intra- and postoperative complications, and cumulative revision rate. The patients were grouped based on preoperative diagnosis to compare postoperative outcomes across two broad groups. Results: The median follow-up period was 32.8 months (interquartile range, 12.6-66.6 months). The 1-year visual analog scale, range of motion, and Constant and ASES functional scores were comparable between RSAs performed to treat shoulder trauma and that performed for arthritis. The overall complication rate was 20.4%, with patients with a preoperative diagnosis of arthritis having significantly more complications than those with a preoperative diagnosis of trauma (34.8% vs. 7.7%). Conclusions: Patients who underwent RSA due to a proximal humeral fracture or dislocation did not fare worse than those who underwent RSA for arthritis at 1 year, in terms of both functional and radiological outcomes.

• The Journal of Advanced Prosthodontics
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• 제3권2호
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• pp.101-105
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• 2011

Maxillofacial prosthodontics is an art and science which provides life like appearance to the person with facial deformity. Maxillofacial prosthetic rehabilitation for acquired defects has become more complex and sophisticated with advancement in techniques and materials. This case report describes the clinical and laboratory procedure for fabricating an auricular prosthesis for a patient with trauma related bilateral auricular deformity. Ear prosthesis was fabricated in two parts taking retention from external auditory canal.

• 대한소아치과학회지
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• 제31권4호
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• pp.564-568
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• 2004

치아의 맹출지연을 일으키는 여러 원인 중 치아종은 법랑질, 상아질, 치수와 같은 치아를 구성하는 조직을 갖춘 harmartoma로 complex odontoma(복잡 치아종)와 compound odontoma(복합 치아종)로 구분된다. 치아종의 원인에는 외상, 감염, 치아발육상의 장애, 유전적 요인 등을 들 수 있으며, 호발 부위는 상악 전치부와 하악 구치부이다. 이 중 compond odontoma는 악골의 전방부에, complex odontma는 악골의 후방부에 잘 발생하는 경향이 있는데 대부분 악골내에서 발생하지만 드물게 점막을 뚫고 치조골의 상방으로 석회화 된 종괴가 맹출한 형태의 치아종을 erupted odontoma라 한다. erupted odontoma는 매우 드문 질환으로 일반적으로 맹출지연을 일으키지는 않는다. 본 증례는 맹출이 지연된 하악 제 1대구치 치관 상방에 나타난 erupted complex odontoma를 제거 후 치아를 맹출 시키는데 양호한 결과를 얻었기에 보고하는 바이다.