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A Clinical Analysis of Abdominal Stab Wounds (복부 자상의 치료 방법에의 접근)

  • Park, Ji-Yeon;Chung, Min;Lee, Yeong-Don;Lee, Jung-Nam;Lee, Woon-Ki;Park, Yeon-Ho;Baek, Jung-Heum;Park, Heung-Gyu;Kim, Keon-Kuk;Kang, Jin-Mo;Choi, Sang-Tae;Lee, Won-Suk;Park, Seung-Youn
    • Journal of Trauma and Injury
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    • v.23 no.2
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    • pp.134-141
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    • 2010
  • Purpose: A classic approach to abdominal stab wounds has been a routine laparotomy for the purpose of diagnosis or treatment. However, management protocols for abdominal stab wounds are still contentious in most trauma centers. We examined the relationship between the character of the stab wound and the injured intraabdominal organs by retrospectively analyzing the medical records of patients with abdominal stab wounds admitted to Gil hospital, and the findings for our patients are then confronted with a review of the literature. We aimed to propose proper management protocols to approach abdominal stab wounds. Methods: The medical records of all 80 patients sustaining abdominal stab wounds, admitted at the Department of Surgery, Gil Hospital, Gachon Medical School, from January 2004 to December 2008 were retrospectively reviewed. All the abdominal stab wounds were collated based on the site and the character of the injury, investigations performed on admission, results of investigations, operations performed and findings at the time of the operation. Results: The most prevalent age group was patients in their forties and the average age of the patients was 41 years for both genders. The stab wounds were most commonly located at the periumbilical area (16.9%), followed by the epigastric area (15.6%), and 18.2% of the patients had multiple wounds. The most commonly eviscerated organ was the omentum (9 out of 16 cases); 61.7% of non-eviscerated patients underwent a therapeutic laparotomy while 81.3% of eviscerated patients underwent a therapeutic laparotomy. The small bowel was the most commonly injured organ (22.7%, 17 out of 75 injuries). The review revealed a relatively common diaphragmatic injury in abdominal stab wound patients (8 cases, 10.5%). The average hospital stay was 11 days. Conclusion: This review revealed commonly eviscerated and injured intraabdominal organs in abdominal stab wound patients and their relationship with a therapeutic laparotomy. Although the management is still controversial, the authors suggest indications for an immediate laparotomy and a protocol for managing abdominal stab wounds. Hemodynamic instability and peritoneal irritation signs are definite indicators for an immediate laparotomy, but the review revealed intraabdominal organ evisceration alone not to be a statistically significant factor. In addition, the authors suggest that abnormal CT findings can be valuable for making a decision on management of hemodynamically stable stab wound patients. Further study may clarify a role for a more selective approach to operative intervention and for a more extensive use of selective observation.

Analysis of the Risk Factors Influencing the Severity of Injury in Pediatric Multiple Trauma Patients (소아 다발성 외상 환자의 중증도에 영향을 미치는 위험인자에 관한 분석)

  • Lee, Gang-Wook;Kim, Sun-Pyo;Kim, Seong-Jung;Cho, Soo-Hyung;Cho, Nam-Soo
    • Journal of Trauma and Injury
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    • v.23 no.2
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    • pp.68-74
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    • 2010
  • Purpose: The purpose of this study is, first, to analyze the risk factors that influence the severity of injury in pediatric multiple trauma patients and, second, to present solutions for the problems related to the treatment of such patients. Our living situations are so complicated that the danger of accidents is truly open to children who are not prepared. We need to draw attention to the increased numbers of various accidents involving children. Methods: We studied patients who visited the Emergency Medical Center at Chosun University Hospital from January 1, 2006, to December 31, 2008. Using medical records, we evaluated the general characteristics: the mechanism of injury, the vital signs, the revised trauma score (RTS), the injury severity score (ISS), and the hemoglibin value, which was checked at the time of visit, and the presence or the absence of emergent on regular surgery. We divided the level of injury as follows: light level (1-8 points), mid level (9-15 points), and serious level (above 16 points). We analyzed the medical data by using SPSS 17.0 for windows. Results: The average age of the patients examined was 8.6 years. The number of 6- to 11-year-old patients was 96, which was the largest, but the degree of injury severity was the highest among infant (0-2 years), according to ISS 7.95(${\pm}6.85$). The frequency of accidents was highest on sunny days, and most accidents occurred from 16:00 to 20:00. The cause of multiple trauma for children was the greatest in the traffic accident, (95 patients, 49.0%). In addition, the trauma caused by traffic accidents showed the highest ISS value ($9.02{\pm}6.42$) and the most serious degree (P=0.004). The ISS level of injury ($8.40{\pm}6.64$) for patients moved from a secondary hospital was higher than that ($6.49{\pm}5.57$) for patients who visited the medical center directly. The severity of injury was highest for patients who used a 119 ambulance ($8.84{\pm}5.80$). According to the injured parts of body, Injuries to the arms and the feet most frequent (79 patients, 40.7%), but the level of injury was the highest for internal organs and chest, $16.42{\pm}8.56$ and $11.23{\pm}6.97$, respectively. Conclusion: We used Abbreviated Injury Scale (AIS) in order to examine the characteristics by injured body part for pediatric multiple trauma patients. Because the degree of injury was the highest for internal organs or the chest, we need to more seriously examine and provide for patients who are suspected of having injuries to the internal organs or the chest. We need to quickly determine the need for surgery in patients with serious injuries to the arms and the feet, which is the greatest in frequency. In particular, we need to consider the surgical care of patients who are not very high in the severity of injury to their brains.

Radiation Therapy for Operable Breast Cancer after Conservative Surgery (유방암환자의 유방보존수술 후 방사선 치료 성적)

  • Lee, Myung-Za;Chun, Ha-Chung
    • Radiation Oncology Journal
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    • v.20 no.4
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    • pp.309-315
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    • 2002
  • Purpose : To evaluate the result of conservative management on recurrence, survival and prognostic factors of patient with operable breast cancer. Materials and Methods : Fifty three patients, treated for localized breast cancer by lumpectomy or quadrantectomy followed by radiotherapy between January 1985 and December 1996, were retrospectively studied. All patients followed up for at least five years. Their median age was 43 years $(range\;24\~72)$. The tumor stages were as follows : T1 in 30 patients, T2 in 21, Tis in 2. Thirty-eight patients had negative and 15 had positive axillary nodes. The histological types were 42 infiltrating ductal, 2 infiltrating lobular, and 2 intraductal carcinomas with 7 other histologies. The tumor locations were the outer quadrant in 38 breasts, the inner quadrant in 13 and central in 2. Radiation doses of $46\~50\;Gy$ were given to the entire breast areas with additional doses of 14-18 Gy delivered to the tumor bed areas. Results : The overall five and 10 yea actuarial and disease free survivals were $94.3\%\;and\;92.4\%,\;91.2\%\;and\;81\%$, respectively. The overall five year survivals were $100\%$ in stage I and IIa, and $66.7\%$ in stage IIb and IIIa tumors. Seven patients failed either locally or distantly. Incidence of local failure and distant metastasis for the first failure were $7.5\%\;and\;5.7\%$, respectively. Local recurrence appeared within 2 years of treatment at the primary site and after more than 8 years outside of primary lesion, whereas distant metastasis appeared between 2 and 6 years following treatment. The overall recurrences were high at a young age (< or = 35 years), with 5 out of 12 (2 local, 3 distant), and in T2 lesions with 5 out of 21 (1 local, 3 distant, and 1 in both). Distant metastasis was high in the positive axillary lymph node group with 4 out of 15 $(26.6\%)$. A high incidence in the axillary node was noted at a young age with 7 out of 12 $(58.3\%)$ and in T2 lesions with 8 out of 21 $(38.4\%)$. A young age, positive axillary node and large tumor size were all related with poor survival. Conclusion : Based on this study, lumpectomy or quadrantectomy, followed by radiation appears to be an adequate therapeutic method in operable breast cancer. A long term follow-up is necessary because a recurrence of breast can occur long time after treatment. The poor prognostic group, especially young patients with an aggressive biological behavior needs more effective treatment modalities to improve their survival.

Modification of Late Radiation Response of Rat Salivary Glands by Pentoxifylline and Diltiazem (쥐의 타액선 방사선조사 후 만성반응에 Pentoxifylline과 Diltiazem이 미치는 영향)

  • Suh, Hyun-Suk;Yang, Kwang-Mo;Kang, Yun-Kyung
    • Radiation Oncology Journal
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    • v.17 no.3
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    • pp.230-237
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    • 1999
  • Purpose : To elucidate the effects of pentoxifylline and diltiazem on the late response of the salivary glands of the rat after irradiation. Materials and Methods : Sixteen Sprague-Dawley rats were divided into 4 groups : (a) irradiation alone (b) irradiation with pentixifylline (PTX) (c) irradiation with diltiazem (DTZ) (d) irradiation with both PTX and DTZ. Irradiation was given in a single fraction of 16 Gy using 4 MV photon energy through an anterior port encompassing the left side of the salivary gland leaving the right side of salivary gland as a control. PTX, 20 mg/kg and/or DTZ, 50 mg/kg were infused intraperitoneally before irradiation, Two rats from each group were sacrificed on the 10th week and the rest was sacrificed on the 16th week after irradiation. Histopathologic examinations were undertaken for each section and the proportion of vacuolated cells out of the total number of cells under light microscopic fields was calculated. The statistical significance in the difference of the proportion of the vacuolated cells among the experimental groups was evaluated by a $x^2$-test. Results : Irradiated salivary glands of the 10th week group revealed markedly increased number of vacuolated cells compared to those of unirradiated control. The proportion of vacuolated cells was significantly reduced in both the PTX group (p value=0.001) and the combined PTX and DTX group compared to those of irradiation alone group. The DTZ alone group did not reveal the significant reduction of vacuolated cells compared to those of irradiation alone group (p value, >0.05). The 16th week groups revealed similar findings to those of the 10th week group, but the degree of chronic inflammatory cell infiltrates and interstitial fibrosis was increased and the number of acinar cells was reduced compared to those of the 10th week group. Conclusions : PTX significantly reduced the late radiation response of salivary glands, but DTZ did not reduce the same degree as PTX did. Taking the positive results of this study into consideration, it seems reasonable to apply PTX into the clinical trial for the head and neck irradiation to reduce the late radiation sequelae of salivary glands in the near future. At the same time the further experiment to clarify the subcellar mechni는 involved in PTX should be preceded.

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Increased Catalase Activity by All-trans Retinoic Acid and Its Effect on Radiosensitivity in Rat Glioma Cells (백서 교종 세포에서 레티노인산에 의한 카탈라제의 활성 증가가 방사선감수성에 미치는 효과)

  • Jin, Hua;Jeon, Ha-Yeun;Kim, Won-Dong;Ahn, Hee-Yul;Yu, Jae-Ran;Park, Woo-Yoon
    • Radiation Oncology Journal
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    • v.23 no.4
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    • pp.211-216
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    • 2005
  • Purpose: It has been reported that all-trans retinoic acid (ATRA) can inhibit glioma growing in vitro. However, clinical trials with ATRA alone in gliomas revealed modest results. ATRA has been shown to increase radiosensitivity in other tumor types, so combining radiation and ATRA would be one of alternatives to increase therapeutic efficacy in malignant gliomas. Thus, we intended to know the role of catalase, which is induced by ATRA, for radiosensitivity if radiation-reduced reactive oxygen species (ROS) is removed by catalase, the effect of radiation will be reduced. Materials and Methods: A rat glioma cell line (36B10) was used for this study. The change of catalase activity and radiosensitivity by ATRA, with or without 3-amino-1, 2, 4-triazole (ATZ), a chemical inhibitor of catalase were measured. Catalase activity was measured by the decomposition of $H_2O_2$ spectrophotometrically Radiosensitivity was measured with clonogenic assay. Also ROS was measured using a 2, 7-dichlorofluorescein diacetate spectrophotometrically. Results: When 36B10 cells were exposed to 10, 25 and $50{\mu}M$ of ATRA for 48 h, the expression of catalase activity were increased with increasing concentration and incubation time of ATRA. Catalase activity was decreased with increasing the concentration of AT (1, $10{\mu}M$) dose-dependently. ROS was increased with ATRA and it was augmented with the combination of ATRA and radiation. ATZ decreased ROS production and increased cell survival in combination of ATRA and radiation despite the reduction of catalase. Conclusion: The increase of ROS is one of the reasons for the increased radiosensitivity in combination with ATRA. The catalase that is induced by ATRA doesn't decrease ROS production and radiosensitivity.

Hyperfractionation Radiation Therapy in Advanced Head and Neck Cancer (진행된 두경부암에서 다분할 방사선치료)

  • Kim, Jin-Hee;Ye, Ji-Won
    • Radiation Oncology Journal
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    • v.21 no.2
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    • pp.112-117
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    • 2003
  • Purpose: The effects of hypefractionation radiation therapy, such as the failure pattern and survival, on the treatment results in advanced stage head and neck cancer were studied. Materials and Methods: Between September 1990 and October 1998, 24 patients with advanced stage (III, IV) head and neck cancers, were treated using hyperfractionation radiation therapy in the Department of Radiation Oncology at the Keimyung University Dongsan Medical Center. The male to female ratio was 7 : 1, and the age range from 38 to 71 years with the median of 56 years. With regard to the TNM stage, 11 patients were stage III and 13 were stage IV. The sites of primary cancer were the nasopharynx in six, the hypopharynx in 6, the larynx in five, the oropharynx in three, the maxillary sinus in three, and the oral cavity in one patient. The radiotherapy was delivered by 6 MV X-ray, with a fraction size of 1.2 Gy at two fractions a day, with at least 6 hours inter-fractional interval. The mean total radiation doses was 72 Gy, (ranging from 64.4 to 75.8 Gy). Follow-up periods ranged between 3 and 136 months, with the median of 52 months. Results: The overall survival rates at 3 and 5 years in all patients were 66.7$\%$, and 52.4$\%$. The disease-free survival rates at 3 and S years (3YDFS, 5YDFS) in all patients were 66.7$\%$ and 47.6$\%$. The 3YDFS and 5YDFS in stage III patients were 81.8$\%$ and 63.6$\%$, and those in stage IV patients were 53.8$\%$ and 32.3$\%$. Ten patients were alive with no local nor distant failures at the time of analyses. Six patients (25$\%$) died due to distant metastasis and 12.5$\%$ died due to local failure. Distant metastasis was the major cause of failure, but 2 patients died due to unknown failures and 3 of other diseases. The distant metastasis sites were the lung (3 patients), the bone (1 patient), and the liver (2 patients). One patient died of second esophageal cancer. There were no severe late complications, with the exception of 1 osteo-radionecrosis of the mandible 58 months after treatment. Conclusion: Although this study was peformed on small patients group, we considered hypefractionated radiation therapy for the treatment of advanced stage head and neck cancer might improve the disease free survival and decrease the local failure with no increase in late complications despite of the slight Increase in acute complications.

Radiation Therapy in Elderly Skin Cancer (노령의 피부암에서 방사선치료)

  • Kim, Jin-Hee
    • Radiation Oncology Journal
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    • v.26 no.2
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    • pp.113-117
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    • 2008
  • Purpose: To evaluate the long term results(local control, survival, failure, and complications) after radiation therapy for skin cancer in elderly patients. Material and Methods: The study spanned from January 1990 to October 2002. Fifteen elderly patients with skin cancer were treated by radiotherapy at the Keimyung University Dongsan Medical Center. The age distribution of the patients surveyed was 72 to 95 years, with a median age of 78.8 years. The pathologic classification of the 15 patients included squamous cell carcinoma(10 patients), basal cell carcinoma(3 patients), verrucous carcinoma(1 patient) and skin adnexal origin carcinoma(1 patient). The most common tumor location was the head(13 patients). The mean tumor diameter was 4.9 cm(range 2 to 9 cm). The radiation dose was delivered via an electron beam of 6 to 15 MeV. The dose range was adjusted to the tumor diameter and depth of tumor invasion. The total radiation dose ranged from $50{\sim}80$ Gy(mean: 66 Gy) with a 2 Gy fractional dose prescribed to the 80% isodose line once a day and 5 times a week. One patient with lymph node metastasis was treated with six MV photon beams boosted with electron beams. The length of the follow-up periods ranged from 10 to 120 months with a median follow-up period of 48 months. Results: The local control rates were 100%(15/15). In addition, the five year disease free survival rate(5YDFS) was 80% and twelve patients(80%) had no recurrence and skin cancer recurrence occurred in 3 patients(20%). Three patients have lived an average of 90 months($68{\sim}120$ months) without recurrence or metastasis. A total of 9 patients who died as a result of other causes had a mean survival time of 55.8 months after radiation therapy. No severe acute or chronic complications were observed after radiation therapy. Only minor complications including radiation dermatitis was treated with supportive care. Conclusion: The results suggest that radiation therapy is an effective and safe treatment method for the treatment of skin cancer in elderly patients who achieved a good survival rate and few minor complications.

Histological and Histochemical Studies on the Epididymal Region and Deferent Ducts of the Drakes by the Age in Weeks (오리 부고환(副睾丸) 및 정관(精管)의 주령별(週齡別) 조직학적(組織學的) 및 조직화학적(組織化學的) 연구(硏究))

  • Lee, Jae-Hong;Ha, Chang-Su
    • Korean Journal of Veterinary Research
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    • v.23 no.2
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    • pp.137-148
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    • 1983
  • This study was made for the better information of the male reproductive system on the meat-type drake, Cherry Belly X White Golden. The epithelium of ductules of epididymal region and deferent duct were observed histologically and histochemically with the progress of their development. India-ink absorbability on the luminal epithelium was also investigated after the administration of India-ink. The results are as follows; 1. Rete testis and various round ductules in immature form appeared in epididymis within 6 weeks after hatching, and simple cuboidal and simple columnar epithelium were found in the epithelia of the ductules within 8 weeks after hatching. Larger ductules were found on epididymal surface which was in the developing stage near to the immature efferent ductule. From 10th to 20th week, various ductules appeared in epididymis, and developing form of efferent ductules were much more increased on epididymal surface. The luminal epithelium of the ductules were composed of ciliated simple columnar and pseudostratified ciliated columnar cells. At the same time, deferent duct appeared. From the 21th week, various ductules in epididymis became abruptly matured. Lumen of rete testis was lined by simple squamous or simple cuboidal epithelium, and that of efferent ductules, having many folds and being larger than any others were lined by pseudostratified ciliated columnar epithelium in which ciliated columnar cells, non-ciliated cells(clear cells) and basal cells were noted. Connecting tubules of star shaped lumen were composed of pseudostratified ciliated columnar epithelium in which ciliated columnar cells, nonciliated cells, and basal cells were observed. The luminal surface of epididymal ducts was smooth and has thick pseudostratified columnar epithelium which was composed of high columnar cells and basal cells. From 26th week after hatching, sperm pooling was started in various ductules. 2. From 4th to 10th week, simple cuboidal epithelium of deferent duct transformed to simple columnar epithelium with the progress of aging. At the basement of epithelium, clear round cells were noted. From 12th to 20th week, high columnar cells with enlongated nucleus were noted on the luminal border of deferent ducts, forming folds of pseuclostratified columnar epithelium. From 20th week, the deferent duct started to have septa in it's lumen and composed mainly of pseudostratified columnar epithelium, and round cells disappeared. From 20th week, the lumen diameter of deferent duct became wider with the progress of aging, but there was no difference among the values of lumen diameter in upper, middle, and lower part of deferent ducts. At 26th week, the pooling period of sperms in deferent ducts, the lumen diameter became rapidly widen, especially in the lower part of deferent ducts. Thickness of muscular layer of ductus deferens showed gradual growth within 24 weeks but did abrupt thickening from 26th week. 3. Saliva resistant PAS granules were dotted on the top of nucleus in efferent ductules epithelium but the amount of the granules were little in the connecting ductules's epithelium. The granules reactive to acid phosphatase were abundant in the some epithelial cells of efferent ductules and connecting ductules, especially above the nucleus of cells. The granules reactive to alkaline phosphatase were noted on the luminal border of efferent ductules. Parts of free border of efferent ductules and middle portion of deferent ducts were stained slightly by alcian blue technique. India ink granules were found mainly in the epithelium of efferent ductules but were few in that of connecting ductules.

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Ecological Characteristics of Red Rice (Local Name "SARE," Oryza sativa L.) and Factors Affecting Its Competition with Rice (적미(赤米) (자생도(自生稻), 속명(俗名) "사레")의 생태적(生態的) 특성(特性) 및 벼와의 경합요인(競合要因))

  • Ree, D.W.;Hong, Y.K.;Kim, J.C.;Kim, Y.H.
    • Korean Journal of Weed Science
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    • v.3 no.2
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    • pp.143-150
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    • 1983
  • Red rice (local name "Sore") as a weed has been a serious threat to rice production in direct-seeded rice culture in Ganghwagun, Gyeonggi province. In the Ganghwagun 508 ha out of 1,420 ha in the Samsanmyeon area is infested with red rice. The average lowland rice yield is about 4,300 kg/ha in the Ganghwagun, but the average upland rice yield is about 2,000 kg/ha in infested area. This study was carried out in order to clarify the ecological characteristics of red rice and factors affecting the competitive ability of five red rice varieties, collected from Samsanmyeon in 1981, with rice cultivar. Five varieties-Monggeunsare, Salsare, Ginkaragsare, Galsaegsalsare, Galsaegkaragsare-showed the same morphological characteristics of cultivated Japonica type, Chuncheongbyeo, but red rice tillers more profusely, is taller and lodges more easily than Chucheongbyeo. It shatters easily about 10-15 days after heading date, and at this time the hull is discolored in yellow or dark brown. There are many types of red rice with short or long owns on the spikelet, occasionally with or without own on the spikelet in the same hill, and the grains are short or long. In red reice leaf blast occurs more severely than in cultivated Indica/Japonica type, Teabaegbyeo, particulary serious in Monggeunsare. When red rice invaded in direct-seeded rice, number of panicles of rice became reduced more than other yield components.

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Effects of Various Physical and Chemical Factors on the Death of Trouble Seaweed Ulva australis (구멍갈파래(Ulva australis) 해조류 사멸에 미치는 여러 물리화학적 요인들의 영향)

  • Kim, Jin-Seog;Kwak, Hwa Sook;Kim, Bo Gwan
    • Weed & Turfgrass Science
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    • v.6 no.3
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    • pp.222-234
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    • 2017
  • Green tides, which was mainly caused by Ulva spp., have been increasing in severity and frequency globally, and have negatively affected on marine ecosystems. This study was conducted to investigate effects of various physical and chemical factors on the death of Ulva australis (ULAUS) and to consider a practical measures useful for alleviating Ulva bloom. Soaking of ULAUS thalli in pure water for 8 hr didn't induce a death, but incubation in 1.0-1.5% salinity for 7 d inhibited sporulation by about 70%. Desiccation gave rise to a serious damage when more than 40-50% of initial fresh weight was lost. ULAUS growth was sensitive to temperature and seriously inhibited from more than $30^{\circ}C$. At $35^{\circ}C$, $40^{\circ}C$, $45^{\circ}C$ and $50^{\circ}C$, treatment time required for 90-95% death of ULAUS thalli was 1 d, 10 min, 30 sec, and 1 sec, repectively. ULAUS growth was seriously inhibited at lower than pH 6.0 and completely dead at pH 4.0. Several compounds for ULAUS control was selected and the chemcals causing a rapid death were oxidants such as hydrogen peroxide and sodium percarbonate. Taken together, our results suggest that low salinities, dryness, pH, high temp. and compounds could be selected for Ulva bloom control, and high temperature and compounds seems to be useful for a development of practical control methods.