• Journal of Trauma and Injury
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• v.28 no.3
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• pp.158-169
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• 2015

Purpose: Frostbite can affect still soldiers. Initial clinical manifestations are similar for superficial and deep frostbite, so early treatment is identical. It is under-estimated by physicians. We try to identify the challenges of managing these complex tissue injuries. Methods: A retrospective analysis of 84 patients hospitalized at AFCH from 2009 to 2015 was conducted. We investigated differences of epidemiological characteristics, identification of soft tissue injury, treatment and complications between superficial (SF: 43; 51.2%) and deep (DF: 41; 48.8%) frostbite. Results: The major (94.0%) developed frostbite in dry circumstances (89.3%). Wet circumstances (66.7%) were more susceptible to DF rather than dry (46.7%). The 38 (45.2%) arrived to specialist within 7days. Most prone sites were feet, followed by hands. Toes had more deep injuries. DF presented more increased levels of ALT, CPK, CKMB, CRP. The bone scan of W+S+ was 48.3%, 87.1% and W+S- was 20.7%, 12.9%, respectively. The treatment resulted in improved or normalized perfusion scan with matching clinical improvement. It was a good tool to assess treatment response. Eighteen normal and 8 stenotic type of PCR resulted in normal with matching clinical improvement. One continuous obstructive waveform led to minor amputation. Twelve underwent both PCR and MRA. Among 6 normal PCR, 5 showed normal and one stenosis in MRA. All 5 stenosis and one obstruction showed the same findings in MRA. It was a good tool to evaluate vascular compromise. They were treated with rapid rewarming (11.6%, 22.0%), hydrotherapy (16.3%, 29.3%), respectively. Six (14.6%) underwent STSG, 2 (4.9%) had digital amputation in DF. Berasil, Ibuprofen, Trental were commonly administered. PGE1 was administered selectively for 6.8, 10.8 days, respectively. Raynaud's syndrome (16.3%), CRPS (4.7%), LOM (14.6%) and toe deformity (4.9%) were specific sequelae. Conclusion: We should recommend intensive foot care education, early rewarming and evacuation to specialized units. The bone scanning and PCR should allow for a more aggressive and active approach to the management of tissue viability.

• Proceedings of the KOSOMBE Conference
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• v.1997 no.11
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• pp.517-527
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• 1997

Magnetic Resonance Spectroscopic Imaging is a methodology combining the imaging and spectroscopy. It can provide the spectrum of each areas of image so that one can easily compare the spectrum of one position to another position of the image. In this study, we developed pulse sequence or the spectroscopic imaging method, RF wave forms or the saturation of water signal, computer simulations to validate our method, and confirmed the methodology with phantom experiment. Then we applied the spectroscopic method to human subject and identified a few important metabolites in in vivo. To develope a water saturating RF waveform, we used Shinnar-Le-Roux algorithm and obtained maximum phase RF waveform. With this RF pulse, it could suppress the water signal to 1:1000. The magnet is shimmed to under 1.0ppm with auto-shimming technique. The saturation bandwidth is 80Hz(2ppm). The water and fat seperation is 3.3ppm(about 140Hz at 1 Tesla magnet), the bandwidth is enough to resolve the difference. But we are more concerned about the narrow window in between the two peaks, in which the small quantity of metabolites reside. We performed the computer simulation and phantom experiments in 8*8 matrix form and showed good agreement in the image and spectrum. Finally we applied spectroscopic imaging to the brain of human subject. Only the lipid signal was shown in the periphery region which agrees with the at distribution in human head surface area. The spectrum inside the brain shows the important metabolites such as NAA, Cr/PCr, Choline. We here have shown the spectroscopic imaging which is normally done above 1.5 Tesla machine can be performed in the 1 Tesla Magnetic Resonance Imaging Unit.