• Journal of Chest Surgery
• /
• 제27권8호
• /
• pp.643-649
• /
• 1994

We evaluated sixteen patients of traumatic diaphragmatic injuries that we have experienced from Jan. 1987 to Aug 1993. Age was ranged from 6 to 71 years, predominantly in the fourth and fifth decades. 13 were male and 3 were female, a ratio of 4.3: 1. Blunt trauma was develped in 11 [Lt 7, Rt 4], penetrating trauma in 5 [Lt 2, Rt 3]. Preoperative diagnosis of diaphragmatic injury was possible in 8 patients [72.2 %] in blunt trauma, and 1 patient [20 %] in penetrating trauma. 8 cases[54.5%] in blunt trauma, and 4 cases in penetrating trauma were treated within 24 hours,meanwhile, patients treated after 10 days were 3, all by blunt trauma.The repair of 16 cases were performed with thoracic approach in 4 cases, thoracoabdominal approach in 3 cases, and abdominal approach in 9 cases. The herniated organs in thorax were stomach [5], colon [3], liver [2], and pancreas [1]. Postoperative complication were developed in 9cases[56.3%] significantly related with delayed operation time [p < 0.01 ]. Hospital mortality was 12.5 % [2/16], and the causes of death were hypovolemic shock in one and hepatic failure due to portal vein rupture in another.

• Journal of Trauma and Injury
• /
• 제32권2호
• /
• pp.122-125
• /
• 2019

A 73-year-old man, who, in an inebriated state, had slipped in a flowerbed and was wounded on the left flank, was transferred to Trauma Center, Gil Medical Center, Gachon University College of Medicine. Based on the chest and abdominopelvic computed tomography, he was diagnosed with multiple rib fractures and hemopneumothorax on the left hemithorax and was found to have a bony fragment in the spleen. He had not presented peritonitis and exsanguinous symptoms during the observation period. Seven days later, computed tomography of the abdomen showed suspected diaphragmatic injury and a retained foreign body in the spleen. On exploration by video assisted thoracoc surgery (VATS), a herniated omentum through the lacerated site of the diaphragm was observed. After omentectomy using Endo Gia, the foreign body in the spleen was observed through the lacerated site of the diaphragm. Traumatic diaphragm rupture with a foreign body, in the spleen, was successfully managed by video assisted thoracic surgery via the lacerated site of the diaphragm.

• Journal of Trauma and Injury
• /
• 제34권2호
• /
• pp.141-145
• /
• 2021

Splenic injury is a common result of blunt trauma, and bleeding occurs mainly inside the splenic capsule and may leak into the peritoneal space. Herein, we report a case where active bleeding occurred in the splenic artery and only leaked into the extraperitoneal space. This is the first case of this phenomenon in a trauma patient in the English-language literature. Bleeding passed through the peritoneum, leaked into the anterior pararenal space, and continued along the extraperitoneal space to the prevesical space of the pelvis. Therefore, on the initial computed tomography (CT) scan, the bleeding appeared to be in the left paracolic gutter, so we suspected mesenteric bleeding. However, after the CT series was fully reconstructed, we accurately read the scans and confirmed splenic injury with active bleeding. If there had been a suspicion of bowel or mesenteric injury, surgery would have been required, but fortunately surgery could be avoided in this case. The patient was successfully treated with angioembolization.

• Journal of Trauma and Injury
• /
• 제35권1호
• /
• pp.66-70
• /
• 2022

The spleen is the most commonly injured organ after blunt abdominal trauma. Nonoperative management (NOM) is the standard treatment for blunt splenic injuries in haemodynamically stable patients without peritonitis. Complications of NOM include rebleeding, new pseudoaneurysm formation, splenic abscess, and symptomatic splenic infarction. These complications hinder the NOM of patients with blunt splenic injuries. We report a case in which a large haemorrhagic fluid collection that occurred after angio-embolisation was resolved by percutaneous drainage in a patient with liver cirrhosis who experienced a blunt spleen injury.

• Journal of Trauma and Injury
• /
• 제24권1호
• /
• pp.37-44
• /
• 2011

Purpose: Recently, social interest in an organized trauma system for the treatment of patients has been increasing in government and academia and the establishment of trauma center is being considered across the country. However, establishing such a system has not been easy in Korea, because enormous experiences and resources are necessary. The objectives of this study were (1) to estimate a trauma patient's demands during the course of treatment and (2) to provide appropriate direction for trauma centers to be established in Korea. Methods: The records of 207 patients who were admitted to the Department of Trauma Surgery in Ajou University Medical Center due to trauma were retrospectively reviewed for a 1 year period from March 2010 to February 2011. Patients were reviewed for general characteristics, number of hospital days, numbers and kinds of surgeries, numbers and kinds of consultations, ISS (Injury Severity Score) and number of patients with ISS more than 15. Results: All 207 patients were enrolled. The average number of hospital days was 36.7 days. The ICU stay was 15.9 days, and the general ward stay was 20.8 days. Admitted patients occupied 9.02 beds in ICU and 11.80 beds in the general ward per day. The average number of surgeries per patient was 1.4, and surgery at the Department of Trauma Surgery was most common. Number of consultations per patient was 14.23, and consultations with orthopedic surgeons were most common. The average ISS was 18.6. The number of patients with ISS more than 15 was 141 (61.8%) and the average number of patients treated per trauma surgeon as a major trauma patient was 94.3. The number of mortalities was 20, and the mortality rate was 9.7%. Conclusion: To reduce mortality and to provide proper treatment of patients with major trauma, hospitals need some number of beds, especially in the ICU, to treat patients and to prepare them for emergent surgery. An appropriate number of trauma surgeons and various specialists for consultation are also needed.

• Journal of Trauma and Injury
• /
• 제22권2호
• /
• pp.172-178
• /
• 2009

Purpose: We performed this study to determine how the emergency trauma team affects the treatment of patients with multiple severe trauma and to discuss the effect and the direction of the emergency trauma team's management. Methods: We performed a retrospective analysis of 518 patients who visited our emergency department with severe trauma from August 2006 to July 2008. We divided the severe trauma patients into 2 groups : patients before and after trauma team management (Group 1 and Group 2). Then, we compared demographic characteristics, mechanisms of injury, and treatment outcomes (lengths of stay in the ED, admission ratio, and in-hospital mortality) between the 2 groups. In the same way, patients with multiple severe trauma were divided into 2 groups, that are patients before and after trauma team management (Group 3 and Group 4) and analyzed. Results: There was no significant difference, except mean age, between groups 1 and 2. In group 4 patients, compared to group 3 patients, the lengths of stay in the ED were lower (p value < 0.001), and the admission ratio were higher (p value = 0.017), but there was no significant difference in the in-hospital mortality between the groups 3 and 4. Conclusion: When patients with multiple severe trauma visit the ED, the emergency trauma team' management can decrease the lengths of stay in the ED and increase the admission ratio, but does not produce a decrease in the in-hospital mortality rate. Further investigations of emergency trauma team management are needed to improve treatment outcomes for patients with multiple severe trauma.

• 한국콘텐츠학회논문지
• /
• 제14권11호
• /
• pp.298-307
• /
• 2014

본 연구는 남, 여 알코올중독자의 외상경험을 살펴보고, 외상경험의 요인을 파악함으로써 사회복지의 실천적 토대를 제공하는 것을 목적으로 하였다. 이를 위해 220명의 알코올중독자를 대상으로 설문조사를 실시하였고, 위계적 회귀분석을 실시하였으며 그 연구결과는 다음과 같다. 첫째, 외상경험 내용을 살펴보면 남성의 경우 아동기 성적학대, 살아오면서 겪을 수 있는 외상(친밀한 사람의 자살, 사망, 질병, 가족분리)의 학대경험이 여성보다 많게 파악되었다. 반면 여성의 경우 아동기 신체적 학대, 정서적 학대, 성적 학대, 성인기 신체적 학대, 정서적 학대, 성적 학대, 살아오면서 겪을 수 있는 외상(사기, 신체적 방임, 유산)의 학대경험이 남성보다 많게 파악되었다. 또한 남성, 여성 알코올 중독자 모두 경제적 곤란의 외상경험을 한 것으로 나타났다. 둘째, 위계적 회귀분석 결과 남성 알코올중독자의 학력과 첫 음주연령이 외상경험에 영향을 주는 요인으로 확인되었다. 여성 알코올중독자의 경우 학력, 종교, 가족력, 재발경험, 병식이 외상경험에 영향을 주는 요인으로 확인되었다. 이러한 결과를 바탕으로 알코올중독자의 회복을 고취하기 위한 실천적 함의를 논의하였다.

• Journal of Trauma and Injury
• /
• 제18권1호
• /
• pp.1-16
• /
• 2005

An ideal trauma care system would include all the components identified with optimal trauma care, such as prevention, access, acute hospital care, rehabilitation, and research activities. Central to an ideal system is a large resource-rich trauma center. The need for resources is primarily based on the concept of being able to provide immediate medical care for unlimited numbers of injured patients at any time. Optimal resources at such a trauma center would include inhouse board-certified emergency medicine physicians, general surgeons, anesthesiologists, neurosurgeons, and orthopedic surgeons. Other board-certified specialists would be available, within a short time frame, to all patients who require their expertise. This center would require a certain volume of injured patients to be admitted each year, and these patients would include the most severely injured patients within the system. Additionally, certain injuries that are infrequently seen would be concentrated in this special center to ensure that these patients could be properly treated and studied, providing the opportunity to improve the care of these patients. These research activities are necessary to enhance our knowledge of the care of the injured. Basic science research in areas such as shock, brain edema, organ failure, and rehabilitation would also be present in the ideal center. This trauma center would have an integrated concurrent performance improvement program to ensure optimal care and continuous improvement in care. This center would not only be responsible for assessing care delivered within its trauma program, but for helping to organize the assessment of care within the entire trauma system. This ideal trauma center would serve as a total resource for all organizations dealing with the injured patient in the regional area.

• Journal of Nutrition and Health
• /
• 제25권3호
• /
• pp.248-255
• /
• 1992

This study was performed to investigate the effects of dietary protein content on recovery of laparotomized rats in terms of urinary epinephrine and norepinephrine plasma epinephrine and norepinephrine, . Fortyeigh male Sprague Dawley rats average-weighing 160g were divided into two diet groups ; LPD(10% low protein diet) group HPD(25% high protein diet) group After 3 days of adaptation period rats were given experimental diet for 14 days. Experimental period consists of 7-days pre-trauma and 7-days post-trauma period. Rats were laparotomized by 4cm abdominal incision under sodium pentobarbital anesthesia. During 7-days before and after the surgery urine and plasma were collected for the analysis of epinephrine and norepine-phrine. The results are as follows: 1) After laparotomy urinary epinephrine level was not increased in two diet groups. Urinary epinephrine concentration of rats in LPD group was considerably increased in post-trauma day 3 and thereafter gradually reduced. By post-trauma day 4 however urinary epinephrine concentration of rats in HPD groups was recovered to pre-trauma level 2) Urinary norepinephrine concentration of rats in LPD group was significantly increased after trauma(p<0.01) and the difference between LPD and HPD in post-trauma average norepinephrine concentration was not significant. 3) Post-traum average plasma epinephrine concentration was higher but not significant than that of pre-truma average in both groups [LPD(19.88ng/ml vs 20.93ng/ml) HPD(17.20ng/ml vs 19.37ng/ml)] 4) Plasma norepinephrine concentration of rats in LPD group was significantly increased in post-trauma period(p<0.01) In HPD group however post-trauma average plasma norepi-nephrine concentration was significantly lower than pre-trauma average. Thus the results suggest that norepinehrine concentration was affected by trauma and rats in HPD group excreted less amount of norepinephrine than rats in LPD group.

• Journal of Trauma and Injury
• /
• 제34권3호
• /
• pp.147-154
• /
• 2021

Purpose: We analyzed the characteristics and outcomes of patients with bicycle-related injuries at a regional trauma center in northern Gyeonggi Province as a first step toward the development of improved prevention measures and treatments. Methods: The records of 239 patients who were injured in different types of bicycle-related accidents and transported to a single regional trauma center between January 2017 and December 2018 were examined. This retrospective single-center study used data from the Korea Trauma Database. Results: In total, 239 patients experienced bicycle-related accidents, most of whom were males (204, 85.4%), and 46.9% of the accidents were on roads for automobiles. Forty patients (16.7%) had an Injury Severity Score (ISS) of 16 or more. There were 125 patients (52.3%) with head/neck/face injuries, 97 patients (40.6%) with injuries to the extremities, 59 patients (24.7%) with chest injuries, and 21 patients (8.8%) with abdominal injuries. Patients who had head/neck/face injuries and an Abbreviated Injury Score (AIS) ≥3 were more likely to experience severe trauma (ISS ≥16). In addition, only 13 of 125 patients (10.4%) with head/neck/face injuries were wearing helmets, and patients with injuries in this region who were not wearing helmets had a 3.9-fold increased odds ratio of severe injury (AIS ≥2). Conclusions: We suggest that comprehensive accident prevention measures, including safety training and expansion of safety facilities, should be implemented at the governmental level, and that helmet wearing should be more strictly enforced to prevent injuries to the head, neck, and face.