• 대한정형외과스포츠의학회지
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• 제9권1호
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• pp.58-64
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• 2010

목적: 최근 교통 수단 및 레저 수단으로써 자전거 이용이 증가함에 따라 자전거 관련 수상 환자도 증가하는 추세이다. 본 저자들은 자전거 사고로 인해 입원 치료를 시행한 환자들의 사고 유형에 대해 분석하였다. 대상 및 방법: 본 연구는 2008년 01월 01일부터 2009년 05월 31일까지 자전거 주행중 사고로 인해 본원에 입원한 75명의 환자 중 추시 가능하였던 71명을 대상으로 하였다. 남자 54명 및 여자 17명이었고 평균 나이는 36.7세였다. 수상 정도, 수상 부위, 수상 기전, 수상 장소, 자전거 종류, 자전거 이용 목적, 동반 탑승 혹은 화물 적재 여부, 계절 그리고 보호구 착용 여부 등을 Injury Severity Score( ISS)를 이용하여 분석하였다. 결과: Injury Severity Score 는 1점이 11례, 4점이 41례, 5점이 2례, 9점이 13례, 13점이 1례,16점이 2례 및 29점이 1례였다. 상지 및 하지의 골절 46례중 수술적 치료를 필요로 하였던 환자는 36례였고, 이는 전체 환자의 50.7 %였으며, 척추체 골절, 안면부 손상 및 복부장기 손상으로 인해 수술적 치료를 시행한 환자는 각각 2례,8례 및 1례였다. 두부 손상은 전체 10례였는데, 이중 중환자실 치료를 필요로 할 정도로 심각한 손상은 3례로 전체 환자의 4.2%였다. 결론: 자전거 사고를 방지하기 위해서는 자전거 전용 도로 확충, 안전 교육 및 헬멧을 포함한 상지 및 하지 보호대 착용 등의 사고 예방 노력이 필요할 것으로 사료된다.

• 동의생리병리학회지
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• 제21권4호
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• pp.835-841
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• 2007

The followings are concluded from the treatment of headache in Hyungsang medicine, focussed on 11 kinds of headaches in Donguibogam. Headache is classified into overall headache and migraine according to the affected region. The causes are divided into exogenous affection and internal injury; The former brings on headache due to Wind-Cold and headache due to Damp-Heat. The latter, reversal headache, headache due to adverse rising of phlegm, headache due to regurgitation of Gi, headache due to excessive Heat, headache due to excessive Damp, true headache, and alcoholic headache. Headache due to internal injury generally tends to show deficiency syndrome with external affection. Headache due to exogenous affections is common to those who have big head or white skin and to Bangkwang type, and woman. The primary causes are Wind-Cold and Wind-Heat. When the body is observed in the perspective of eight phases, Damp-Heat is to be produced in the front, and Dry-Damp, in the back. Headache due to Damp-Heat is susceptible to Yangmyeong meridian type whose body develops more in the front and to woman. In the perspective of the upper and the lower, Yangdu(that is, head) is related to Eumdu(that is, glans of penis). Headache is also caused by the problems of Eumdu ,such as deficiency of Essence in man, pathologic change of uterus in women, and San syndrome in lower abdomen. In the case of man, headache is frequently severe and difficult to treat because head is a root for man. Disharmony of Gi and blood between the right and the left brings out migraine and headache due to regurgitation of Gi. Migraine is usually accompanied by symptoms of exogenous affection and often afflicts Gi-type, Shin-type, Soyang meridian type, deer type, and Dam-type. Headache due to regurgitation of Gi is brought by Gi deficiency or blood deficiency so that symptoms of exogenous affection do not show. It is mainly common with old people and those who have sunken eyes induced by deficiency of stomach Gi. In the perspective of the upper, the middle, and the lower, the pathologic change of head, chest and abdomen also bring about headache. The pathologic cause of head is Wind-Heat ,which triggers overall headache, migraine, headache due to Wind-Cold, headache due to excessive Heat, The pathogen of chest is phlegm-Fire and brings out headache due to Damp-Heat and headache due to adverse rising of phlegm. The pathologic factor in abdomen is Cold-Damp and produces headache due to adverse rising of phlegm and headache due to excessive Damp. In case of women, headache is generally caused by phlegm-Fire and retention of undigested food.

• Journal of Chest Surgery
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• 제13권3호
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• pp.212-218
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• 1980

A severe crushing injury of the chest produce a very striking syndrome referred to as traumatic asphyxia. This syndrome is characterized by bluish-red discoloration of the skin which is limited to the distribution of the valveless veins of the head and neck. And also if it is characterized by bilateral subconjunctival hemorrhages and neurological manifestations. But these clinical entities faded away progressively in a few weeks. Apporximately 90% of the patients who live for more than a few hours will recover from traumatic asphyxia when it occurs as a single entity. And so, death results from either severe associated injuries of from subsequent infection, rather than from pulmonary or cardiac insufficiency in traumatic asphyxia. We have experienced 4 cases of traumatic asphyxia with severe crushing thoracic injuries at department of the chest surgery, Captial Armed forces General Hospital during about 3 years from April 1977 to Aug. 1980. The 1st 22 year-old male was struct 2$\frac{1}{2}$ ton truck on the road and was transferred to this hospital immediately. He had taken tracheostomy due to severe dyspnea with contusion pneumonia and for removal of a large amount of bronchial secretion. The 2nd case was 23 year-old male who was got buried in a chasm. In this case, the heavy metal post tumbled over him back while at work. The 3rd case was 39 year-old male who leapt out of a window in 5th story while fire broke out in living room by oil stove heating. He had multiple rib fracture with right hemothor x and right colle's fracture and pelvic bone fracture. The last 22 year-old male was run over by a gun carriage. The wheel of this gun carriage passed over his thorax and right chin. He was brought to this hospital by helicopter. when he was first examined at emergency room, he was in semicomatose state and has pneurmomediastinum with multiple rib fracture and severe subcutaneous emphysema. As soon as he arrived, bilateral closed thoracostomy was performed and cardiopulmonary resuscitation was done. In hospital 8th weeks, chest series showed fibrothorax in right side even if chest wall stabilized. All 4 cases had multiple petechiae over their facees and chest and bilateral subconjunctival hemorrhages referred to as traumatic asphyxia. 3 cases except one case who received splenectomy, had been suffered from contusion pneumonia and had been treated with respiratory care. In these 3 cases, they had warning of impending injury before accident, and took a deep breath hold it and braces himself. And also, even if he had not impending fear in remaining one case, he had taken a deep breath and had got valsalva maneuver for pulling off the heavy metal post. Intrathoracic pressure rose suddenly and resulted to traumatic asphyxia in this situation. All these cases were recovered completely without sequelae except one fibrothorax, right.

• Journal of Korean Neurosurgical Society
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• 제55권4호
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• pp.195-199
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• 2014

Objective : Age is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital. Methods : We collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3--8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator. Results : Types of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares. Conclusion : Ethical training and developing decision-making skills are necessary including shared decision making.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권5호
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• pp.307-312
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• 2019

Klippel-Feil syndrome is characterized by congenital fusion of two or more cervical vertebrae, a low hair line at the back of the head, restricted neck mobility, and other congenital anomalies. We report a 16-year-old young man with Klippel-Feil syndrome, Sprengel deformity of the right scapula, thoracic kyphoscoliosis, and mandibular prognathism with an anterior open bite. He was treated with orthodontic treatment and maxillofacial surgery. An anticipated difficult airway due to a short neck with restricted neck movements and extrinsic restrictive lung disease due to severe thoracic kyphoscoliosis increased his anesthesia risk. Due to his deviated nasal septum and contralateral inferior turbinate hypertrophy, we chose awake fiber optic orotracheal intubation followed by submental intubation. Considering the cervical vertebral fusion, he was carefully positioned during surgery to avoid potential spinal injury. He recovered well and his postoperative course was uneventful.

• Journal of Korean Neurosurgical Society
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• 제51권4호
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• pp.215-218
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• 2012

Objective: Traumatic epidural hematomas (EDHs) in children are a relatively unusual occurrence. The cause and outcome vary depending on period and reg ion of study. The aims of this analysis were to review the cause and outcome of pediatric EDHs nowadays and to discuss outcome-related variables in a large consecutive series of surgically treated EDH in children. Methods: This is a retrospective review of 29 patients with surgically treated EDHs between Jan 2000 and February 2010. Patients' medical records, computed tomographic (Cl) scans, and, if performed, magnetic resonance imaging (MRI) were reviewed to define variables associated with outcome. Variables included in the analysis were age, associated severe intracranial injury, abnormal pupillary response, hematoma thickness, severity of head injury (Glasgow Coma Scale score), parenchymal brain injury, and diffuse axonal injury. Results: The mean (SO) age of the patients was 109 months (0-185 months). Most of the injuries with EDHs occurred in traffic accident (14 cases, 48.2%) and followed by slip down in 6 cases and falls in 6 cases. There were one birth injury and one unknown cause. EDHs in traffic accidents occurred in pedestrians hit by a motor vehicle, 9 cases; motorbike and car accidents, 5 cases and bicycle accidents, 1 case. The locations of hematoma were almost same in both sides (left side in 15 cases). Temporal lobe is the most common site of hematomas (13 cases, 44%). The mean size of the EDHs was 18 mm (range, 5-40 mm). Heterogeneous hematomas in CT scans were 20 cases (67%). Two patients were referred with unilateral or bilateral dilated pupil(s). There was enlargement of EDH in 5 patients (17%). All of them were heterogeneous hematomas in CT scans. Except for 4 patients, all EDHs were associated with skull fracture(s) (87%). There was no case of patient with major organ injury. CT or MRI revealed brain contusion in 5 patients, and diffuse axonal injury in one patient The mortality was zero, and the outcomes were excellent in 26 and good in 2 patients. None of the tested variables were found to have a prognostic relevance. Conclusion: Regardless of the EDH size, the clinical status of the patients, the abnormal pupillary findings, or the cause of injury, the outcome and prognosis of the patients with EDH were excellent.

• Journal of Trauma and Injury
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• 제28권3호
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• pp.190-194
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• 2015

Blunt cerebrovascular injury is defined as a vertebral or carotid arterial structural wall injury resulting from nonpenetrating trauma. Complete traumatic internal carotid artery occlusion is very rare condition accounting for 0.08~0.4 0f all trauma patients and believed to be associated with the greatest risk of ischemic stroke reported in 50~90% in a few small series. A 55-year-male was admitted with drowsy mentality and severe headache after a fall down accident. Brain computed tomography showed a subdural hematoma at the both frontal area with a fracture of the occipital skull bone. Two days after admission, he suddenly complained with a right side hemiparesis of motor grade 2. Brain magnetic resonance diffusion demonstrated multiple high flow signal changes from the left frontal and parietal lesion. Computed tomographic angiogram (CTA) revealed absence of the left ICA flow. Trans femoral cerebral angiography (TFCA) showed complete occlusion of the left internal carotid artery (ICA) at ophthalmic segment in the left ICA angiogram and flows on the left whole hemispheric lesions through the anterior communicating artery in the right ICA angiogram. We decided to conduct close observations as a treatment for the patient because of acute subdural hematoma and sufficient contralateral cerebral flow by perfusion SPECT scan. Two weeks after the accident, he was treated with heparin anticoagulation within INR 2~4 ranges. He recovered as the motor grade 4 without another neurologic deficit after 3 months.

• Journal of Trauma and Injury
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• 제30권4호
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• pp.145-157
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• 2017

Purpose: We accessed epidemioloy of 908 acute burns (7 years) in the military, of injuries and propose proper educational programs to suit community. Methods: We surveyed burn demographics, circumstances of injuries, size, result of treatment. Results: The mean age was 20.6 years. The flame burns (FB) (325, 35.8%) were most common, followed scald (SB) (305, 33.6%), contact (CB) (219, 24.1%), electric (EB) (45, 5.0%) and chemical burns (ChB) (14, 1.5%). The more occurred during winter (29.7%). SB had mean 3.9% total body surface area (TBSA). The 251 (82.3%) had superficial burns by spillage of hot water/food on lower limbs (45.6%), feet (33.8%) in summer (34.8%), treated with simple dressing (92.8%). Morbidity rate was 5.6%; post traumatic stress disease (PTSD) (0.7%). FB had large wound (9.3% TBSA). The 209 (64.3%) had superficial burns by ignition to flammable oils (31.7%) and bomb powders (29.2%) on head/neck (60.3%), hands (58.6%) in summer (31.7%), autumn (30.2%). They underwent simple dressing (83.4%) and skin graft (16.0%). Morbidity rate was 18.8%; PTSD (10.5%), inhalation injuries (4.0%), corneal injury (3.7%), amputations (0.9%), and mortality rate (1.2%). CB had small (1.1% TBSA), deep burns (78.5%) by hotpack (80.4%) on lower limbs (80.4%). The more (59.8%) underwent skin graft. EB had 6.8% TBSA. The 29 (64.4%) had superficial burns by touching to high tension cable (71.1%) on hand (71.1%), upper limbs (24.4%) in autumn (46.8%). They underwent simple dressing (71.1%) and skin graft (24.4%). They showed high morbidity rate (40.0%); loss of consciousness (13.3%), nerve injuries (11.1%), neuropathy (8.9%), amputations (2.2%), and mortality rate (2.2%). Conclusions: The cook should wear apron over the boots during work. The lighter or smoking should be strictly prohibited during work with flammable liquids or bomb powders. Don't directly apply hotpack to skin for a long time. Use insulating glove during electric work. Keep to the basic can prevent severe injury and proper education is important.

• Clinics in Shoulder and Elbow
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• 제1권2호
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• pp.167-174
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• 1998

Since the first description by Cotton, there have been sporadic reports about the inferior subluxation of the shoulder. Nevertheless there is still a lack of consensus regarding the mechanism of occurrence, evolution and treatment. We have experienced six cases of inferior sublusation(five cases after trauma and one case after surgery) which resolved over time. Analysis of the clinical informations including serial radiographs, data from clinical examination and electromyography(EMG) revealed the following results. All the five post-traumatic inferior subluxations were noted in women with an average age of 59 years after direct trauma resulting in fracture of the proxiaml hrnerus(4) or clavicle(1), of which nerve injury was proven by EMG in three. One case occurred after Bankart repair by stretch injury to the axillary nerve. The presenting symptom was unusually severe pain on passive motion. Absence of anterior or posterior displacement wasl confirmed by radiographs. All the cases seemed to have delayed onset of subluxation except one. The subluxed hu.meral head was concentrically reduced at an average 11 weeks(range 3-23 weeks) from the supposed time of occurrence and the acromiohumeral interval measUred on the standing anteroposterior radiographs decreased to 9.4 mm ftom 23 mm. Improvement of pain paralled the reduction. In conclusion, the most common cause of transient inferior subluxation was nerve injury in ou~ series and the prognosis was excellent, however protraction of recovery or leaving permanent subluxation would be possible if .the injured nerve is unrecoverable.

• Journal of Chest Surgery
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• 제39권2호
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• pp.127-133
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• 2006

배경: 외상에 의한 사망의 시간적 분포에 대한 연구에 의하면 외상 후 수 시간 이내의 초기 사망이 높은 비율을 차지하고 있다. 외상체계의 발달로 전체적인 외상 사망은 감소하였으나 아직까지도 외상은 주요한 사망 원인 중 하나이다. 저자들은 외상 사망의 분포에서 과반수 이상을 차지하는 초기사망의 위험 요인을 알아보고자 하였다 대상 및 방법: 1994년 1월부터 2003년 12월까지 3차 의료기관 응급의료센터에 내원한 외상환자 중 사망한 환자 400예를 후향적으로 분석하여 사망의 시간적 분포와 손상의 부위에 따른 사망의 시간적 분포를 분석하였다. 외상 사망에 있어서 초기 6시간 이내에 사망한 환자와 6시간 이후에 사망한 환자를 비교하여 초기 사망의 위험요소를 분석하였다. 결과: 손상의 종류에 따른 외상 사망의 분포는 두부와 복부 손상은 2상 분포를 보였으나 흥부 손상의 경우는 초기 사망이 대부분을 차지하였다. 초기 사망군에서 GCS가 5.86$\pm$4.15로 후기 사망군 8.24$\pm$5.02로 유의한 차이를 보였으며(p<0.05), 흉부 AIS에서도 초기 사망군 2.66$\pm$1.87로 후기 사망군 1.55$\pm$1.76 으로 초기 사망군에서 손상이 더 심한 것을 나타났다(p<0.05). 초기 사망군의 위험요소 분석에서는 119 구급대에 의해 이송되지 않은 경우(교차비 3.474),높은 흉부 AIS (교차비 1.491), 낮은 GCS (교차비 0.859)가 각 주요 위험요소로 나타났다. 걸론. 외상에 의한 사망에서 지금까지 외상체계의 초점이 되었던 초기 사망의 원인 중 뇌신경계 손상과 출혈뿐만 아니라, 흥부 손상 역시 초기 외상사망의 중요한 요인이다. 따라서 외상환자의 초기 처치에서 흥부손상에 대한 적극적인 검사와 외과적 처치가 필요할 것이다.