• Clinics in Shoulder and Elbow
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• v.1 no.2
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• pp.266-277
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• 1998

Forty-nine partial thickness rotator cuff tears underwent arthroscopic debridement or repair, and were followed up for a minimum of two years. Follow-up evaluations of the results were completed using a detailed functional questionnaire which was comprised of a rating of the UCLA shoulder scale and return to the previous sports activity and job. The average age of the 49 study patients was 46.5 years(range, 14 to 67 years). The patients were divided into four groups on the basis of the onset of the patient's symptoms. Thirty-five patients(72%) had partial tearing only on the articular surface, six(12%) on the bursal surface, and eight(16%) on both surfaces. Group I consisted of 21 patients with an average age of 56.7. Partial tearing in group I was attributed to the impingement syndrome. In group II, partial tearing of the rotator cuff was related to the anterior instability of the shoulder. This group included 9 patients with an average age of 27.9. In group III, all of the 8 patients were overhead athletes with an average age of 21.8. In this group, no isolated instances of significant trauma were related to the development of the shoulder pain. In group IV, 11 patients noted that a significant traumatic event preceded the onset of their pain. The average age of the patients was 34.9. Overall, 82% of the patients demonstrated satisfactory results and 18% revealed unsatisfactory results. The worst UCLA score and rate of return to the prior activity was noted in group III. In conclusion, partial thickness rotator cuff tear can be caused by subacromial impingement, instability, repetitive microtrauma, and macrotrauma. Arthroscopic debridement of partial tear of the rotator cuff provides a favorable outcome except in overhead athletes.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.172-177
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• 2012

Purpose: After damage control surgery, abdominal wall closure may be impossible due to increased intra-abdominal pressure (IAP), and primary closure may induce abdominal compartment syndrome. The purpose of this study was to investigate changes in the IAP and the feasibility of abdominal wall closure using artificial mesh. Methods: From July 2010 to July 2011, 8 patients with intra-abdominal hypertension underwent abdominal wall closure using artificial mesh. Medical data such as demographics, diagnosis, operation, IAP, postoperative complications, mortality and length of hospital stays were collected and reviewed, retrospectively. One patient was excluded because of inadequate measurement of the IAP. Results: Seven patients, 4 males and 3 females, were enrolled, and the mean age was 54.1 years old. Causes of operations were six traumatic abdominal injuries and one intra-abdominal infection. The IAP was reduced from $21.9{\pm}6.6mmHg$ before opening the abdomen to $15.1{\pm}7.1mmHg$ after fascial closure. Fascial closure was done on $14.9{\pm}17.5$ days after the first operation. The mean lengths of the hospital and the intensive care unit (ICU) stays were 49.6 days and 29.7 days respectively. Operations were performed $3.1{\pm}1.5$ times in all patients. Two patients expired, and one was transferred in a moribund state. Three patients suffered from complications, such as retroperitoneal abscesses, enterocutaneous fistulas, and bleeding that was related to the negative pressure wound therapy. Conclusion: After abdominal wall closure using artificial mesh, intra-abdominal pressure was well controlled, and abdominal compartment syndrome does not occur. When the abdominal wall in patients who have intra-abdominal hypertension is closed, artificial mesh may be useful for maintaining a lower abdominal pressure. However, when negative pressure wound therapy is used, the possibility of serious complications must be kept in mind.

• Journal of Trauma and Injury
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• v.26 no.1
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• pp.14-17
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• 2013

Purpose: The open abdomen is now the standard of care in various clinical situations, especially it is used to treat abdominal compartment syndrome. Many techniques have been reported for closure after an open abdomen, but most take a long time for complete definitive closure and are associated with various problems. We describe a technique using biologic mesh that can achieve early definitive closure after an open abdomen. Methods: A 45-year-old man presented to the emergency room with a painful hip and painful lower extremities after a fall from 80 feet. Radiologic examination revealed multiple fractures of the pelvis and low extremities. Abdominal compartment syndrome caused by a retroperitoneal hematoma developed during the orthopedic surgery. We performed exploration immediately and closed abdomen temporarily. A peritoneal graft of porcine dermal collagen with anterior myofascial approximation of the rectus abdominis muscles and sliding skin flap was performed three days after the previous surgery. Results: There were no complications related to the wound. The patient was transferred to the Department of Orthopedic Surgery seven days after the initial surgery. Conclusion: Early definitive closure using porcine dermal collagen is a feasible method that can reduce the length of hospitalization and the number of operations for an open abdomen.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.175-182
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• 2013

Purpose: Crushing injuries by car tires result from a combination of friction, shearing, and compression forces and the severity of injury is influenced by the acceleration. Because car-tire injuries of the lower leg in children are common these days but they have received little attention; thus, our purpose was to look closely into this problem. Methods: A retrospective analysis was conducted of data from children under 15 years old age who visited an emergency department because of a car-tire-related crushing injury to the lower leg in pedestrian traffic accident from January 2008 to September 2012. The patient's age, sex, site of injury, degree of injury, associated injuries, type of surgery, and complications were reviewed. Results: There were 39 children, the mean age was 8.0 years, and 71.8% were boys. The dorsal part of the leg was involved most frequently. According to the severity classification, 15 children were grade I, 6 were grade II, and 18 were grade III. Among 24 patients, 13 were treated with skin graft and 3 were treated using a sural flap. Twelve patients developed complications, such as hypertrophic scarring, contractures, and deformities with significant bone loss. Conclusion: Various degrees of skin or soft tissue defects were caused in children by car tires. In this study, patients were often also had tendon or bone damage. Proper and timely initial treatments are needed to reduce the incidence of infection, the number of operative procedures, and the hospital stay.

• Archives of Reconstructive Microsurgery
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• v.17 no.1
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• pp.36-41
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• 2008

Surgical treatment of compressive ulnar neuropathy at the elbow has been performed with a wide variety of techniques. Among these techniques, anterior submuscular transposition of the ulnar nerve has been regarded as the method of choice by many authors. It has many advantages including a low recurrence rate, scar-free vascular bed, and protection from repeated trauma to the nerve. However, anterior submuscular transposition is technically demanding and requires more extensive soft tissue dissection. On the other hand, anterior subfascial transposition is less invasive, requires a relatively shorter operation time than the submuscular technique, and also can be done safely even in patiensts with elbow arthritis. We evaluated the clinical results of anterior submuscular transposition compared with anterior subfascial transposition. Fifteen patients underwent anterior submuscular transposition and ten patients underwent anterior subfascial transposition of the ulnar nerve. The mean follow-up time was 15 months (range 10 to 38 months) in the anterior submuscular transposition group and 7 months (range 6 to 15 months) in the anterior subfascial transposition group. According to the outcome status determination algorithm devised by Mowlavi, 3 patients (20%) showed total relief, 10 patiensts (66.7%) improvement and 2 patients (13.3%) no changes in the anterior submuscular transposition group. In the anterior subfascial transposition group, 2 patients (20%) showed total relief, 7 patients (70%) improvement and 1 patient (10%) displayed no changes. Statistically there was no significant difference of the clinical results between the two surgical techniques. Therefore we would suggest anterior subfascial transposition of the ulnar nerve as a preferred method for treatment of cubital tunnel syndrome.

• Journal of Trauma and Injury
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• v.31 no.2
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• pp.51-57
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• 2018

Purpose: Patients with diffuse axonal injury experience various disabilities and have a high cost of treatment. Recent researches have revealed the underlying mechanism and pathogenesis of diffuse axonal injury. This study aimed to investigate the correlation between the radiological grading of diffuse axonal injury and the clinical outcomes of patients. Methods: From January 2011 to December 2016, among 294 patients with traumatic brain injury, 44 patients underwent magnetic resonance imaging (MRI). A total of 18 patients were enrolled in this study except for other cerebral injuries, such as cerebral hemorrhage or hypoxic brain damage. Demographic data, clinical data, and radiological findings were retrospectively reviewed. The grading of diffuse axonal injury was analyzed based on patient's MRI findings. Results: For the most severe diffuse axonal injury patients, prolonged intensive care unit (ICU) stay (p=0.035), hospital stay (p=0.012), and prolonged mechanical ventilation (p=0.030) were observed. However, there was no significant difference in healthcare-associated infection rates between MRI grading (p=0.123). Massive transfusion, initial hemoglobin and lactate levels, and MRI gradings were found to be highly significant in predicting the duration of unconsciousness. Conclusions: This study showed that patients with high grade diffuse axonal injury have prolonged ICU stays and significantly longer hospital stays. Deteriorated mental patients with high energy injuries should be evaluated to identify diffuse axonal injuries by using an appropriate imaging tool, such as MRI. It will be important to predict the duration of consciousness recovery using MRI scans.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.14 no.2
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• pp.168-173
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• 2014

Vascular Ehlers-Danlos syndrome (vEDS) is an autosomal dominant disorder caused by a mutation of the type III collagen (COL3A1). The manifestation of vEDS can be seen in skin, joints, blood vessels, and internal organs. The diagnosis of vEDS often is missed until the patient presents with a life-threatening complication such as spontaneous arterial rupture or bowel perforation. We report a 16-year-old male who had recurrent right thigh hematoma after simple exercise and minor trauma, respectively. He had a history of surgery due to spontaneous colon perforation at his age of 11 years. Gene test of COL3A1 revealed a novel mutation c.2931+dupT.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.21-26
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• 1999

Background: Preoperative blocking of surgical nociceptive inputs may prevent sensitization of central nervous system (CNS) and reduce postoperative pain. The stress responses to surgical trauma consist of increase in catabolic hormones and decrease in anabolic hormones. We studied whether preoperative low dose epidural bupivacaine and morphine could affect postoperative pain, changes plasma cortisol, and serum glucose. Methods: Thirty patients undergoing total abdominal hysterectomy were randomly assigned to one of three groups. General anesthesia was induced in all patients and after that, epidural blocks were done except the control group (n=10) patients. Preoperative block group (n=10) received 0.5% bupivacaine 50 mg and morphine 2 mg epidurally as a bolus before operation and followed by 0.1% bupivacaine $5\;mghr^{-1}$ and morphine $0.2\;mghr^{-1}$ for 10 hours. Postoperative block group (n=10) received the same doses of bupivacaine and morphine under the same method postoperatively. Postoperative pain relief was provided with i.v. fentanyl through Patient-Controlled-Analgesia Pump. Postoperative pain by visual analogue scores (VAS), analgesic requirement (first requirement time, total amounts used), side effects, plasma cortisol level and serum glucose level were compared. Results: Until postoperative 6 hrs, VAS of control group was higher than those of the epidural groups. No difference was observed in VAS between the two epidural groups. First analgesics requirement time and total amounts of used analgesics were not different between the two epidural groups, but first analgesic requirement time of preoperative block group was significantly prolonged compared with control group. Plasma cortisol and serum glucose levels were not different among groups. Conclusions: Low dose preoperative epidural bupivacaine and morphine could not reduce postoperative pain, plasma cortisol level and serum glucose level compared with postoperative block group.

• Journal of Korean society of Dental Hygiene
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• v.6 no.3
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• pp.203-218
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• 2006

The purpose of this study was to measure dental hygienists' perception of the usefulness of clinical practice training. A total of 195 dental hygienists participated in the study. The findings of the study were analyzed according to age, the type of hospitals where respondents were working, experience in clinical practices and educational level as follows: 1. There were statistically significant differences in perception of the usefulness of the practice of amalgam filling preparation performed for dental operation among subjects at different ages (p<.01). 2. There were statistically significant differences in perception of the usefulness of the practice of paralleling technique(p<.001), the practice of amalgam filling preparation(p<.01) and the practice of trauma treatment preparation(p<.05) among subjects working at different clinics 3. Significant differences were observed in perception of the usefulness of the practice of sterilization(p<.05), the practice of suction(p<.05), the practice of history taking preparation (p<.01) and the practice of halitosis patient management preparation(p<.05) among subjects with different years of experience in clinical practices. 4. Significant differences were found in perception of the usefulness of the practice of paralleling technique among subjects with different education levels. The findings of the study suggest the need for strengthening education programs for clinical training content and practices which subjects considered important for their job. At the same time, the study emphasizes the need for developing training programs designed to produce dental hygiene preceptor who can provide dental hygienists with practical clinical training in cooperation with college and dental clinics.

• Archives of Reconstructive Microsurgery
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• v.18 no.2
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• pp.67-74
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• 2009

Purpose: The etiology and treatment strategy of the anterior interosseous nerve (AIN) syndrome are still controversial. Seven patients with the AIN syndrome who were treated by surgical exploration and neurolysis were reviewed at a mean of 35.9 months follow up period. Materials & Methods: There were six men and one woman. The mean age was 37.3 years, ranging from 26 to 59. No patient was related to trauma and associated neurological lesion. Surgical exploration was performed at 7.7 months after onset of paralysis. Results: All except one patients experienced pain around the elbow region before the onset of the palsy. On 7 patients, only the flexor pollicis longus was paralysed in 1, only the index flexor digitorum profundus in 2, and none had paralysis of the middle. The most common compression structures were fibrous bands within flexor digitorum sublimis arcade. However there was no demonstrable abnormality in three. Recovery was complete in all cases within 12 months after surgery. Conclusion: We recommended surgical exploration and neurolysis in patients who have shown no improvement after 6 months of conservative treatment. And careful preoperative examination is essential to avoid misdiagnosis and inappropriate surgery, especially in incomplete AIN syndrome.