• Journal of Trauma and Injury
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• v.22 no.2
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• pp.218-226
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• 2009

Purpose: In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative management. The blood products must be expedited and efficiently to patients in impending shock caused by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically, based on the clinician' and has not been guided by objective parameters, but own opinion, that may result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome. This article presents quickly assessable predictive factors for determining if a blood transfusion is required to improve outcomes in multiple blunt trauma patients admitted to the emergency room. Methods: In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion were subjected to univariate and multivariate logistic regression analysis. Results: Of blunt trauma patients, 9.2% (26/282), received red blood cells in the first 24 hours of care. Univariate analysis revealed significant associations between blood transfused and heart rate (HR) > 100 beats/min, respiratory rate (RR) > 20 breaths/min, Glasgow Coma Scale (GCS) < 14, Revised Trauma Score (RTS) < 11, white blood cell count (WBC) < 4000 or > 10000, and initial abnormal portable trauma series (Cspine lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR > 100 beats/min (EXP 3.2), GCS < 14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors. Conclusion: In our study, systolic blood pressure (SBP) < 90 mmHg, old age > 65 years, hemoglobin < 13g/dL, mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR > 100 beats/min, and GCS < 14 were quickly assessable useful factors for predicting a need for early blood transfusion in blunt trauma patients visiting the emergency room.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.111-124
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• 2013

Purpose: We should prepare proper medical service for disaster control as South Korea is not free from terrorism and war, as we experienced through the two naval battles of the Yeonpyeong, one in 1999 and the other in 2002, the sinking of Cheonan in 2010, and the attack against the border island of Yeonpyeong in 2010. Moreover, North Korea's increasingly bellicose rhetoric and mounting military threats against the world demand instant action to address the issue. The aim of this article is to describe our experience with three patients with combat-related gunshot and explosive injuries to their extremities and to establish useful methods for the management of patients with combat-related injuries. Methods: Three personnel who had been injured by gunshot or explosion during either the second naval battle of the Yeonpyeong in 2002 or the attack against the border island of Yeonpyeong in 2010 were included in our retrospective analysis. There were one case of gunshot injury and two cases of explosive injuries to the extremities, and the injured regions were the left hand, the right foot, and the right humerus. In one case, the patient had accompanying abdominal injuries, and his vital signs were unstable. He recovered after early initial management and appropriate emergency surgery. Results: All patients underwent emergent surgical debridement and temporary fixation surgery in the same military hospital immediately after their evacuations from the combat area. After that, continuous administration of antibiotics and wound care were performed, and definite reconstructions were carried out in a delayed manner. In the two cases in which flap operations for soft tissue coverage were required, one operation was performed 5 weeks after the injury, and the other operation was performed 7 weeks after the injury. Definite procedures for osteosynthesis were performed at 3 months in all cases. Complete union and adequate functional recovery were achieved in all cases. Conclusion: The patient should be stabilized and any life-threatening injuries must first be evaluated and treated with damage control surgery. Staged treatment and strict adherence to traditional principles for open fractures are recommended for combat-related gunshot and explosive injuries to the extremities.

• Archives of Plastic Surgery
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• v.33 no.1
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• pp.39-45
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• 2006

This study is to examine the relationship between TGF-b1 expression and CTGF expression, and to evaluate the effect of Sp1 blockade on the expression of TGF-b1, CTGF and extracellular genes, clones of fibroblasts stably transfected with Sp1 decoy ODN. R-Sp1 decoy ODN was highly resistant to degradation by nucleases or serum, compared to the linear or phosphorothioated-Sp1 decoy ODN. Skin wounds were created on the back of 36 anesthetized rats. They were divided into four groups-the rats with normal skin, with wounded skin without decoy, with wounded skin injected with R-Sp1 decoy, and with wounded skin injected with mismatched R-Sp1 decoy, respectively. Skins were collected at 3rd, 5th, 7th, 14th day after wounding. Cellular RNA was extracted by RT-PCR analysis. TGF-${\beta}1$ and CTGF were deeply related with skin fibrosis during scar formation and it appeared that TGF-${\beta}1$ may cause the induction of CTGF expression. R-Sp1 decoy ODN inhibited TGF-${\beta}1$ and CTGF expression both in cultured fibroblasts and in the skin of rats. These results indicate that targeting Sp1 with R-type decoy efficiently blocks extracellular matrix gene expression, and suggest an important new therapeutic approach to control the scarring in normal wound healing and fibrotic disorders.

• Research in Plant Disease
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• v.11 no.2
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• pp.193-197
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• 2005

The effect of pH on the survival of R. solanacearum and its transmission via roots of tomato in hydroponic culture were studied in laboratory and greenhouse. In laboratory experiment, R. solanacearum could not survive for 24h in nutrient solution with pH of $4{\cdot}0;or\;4{\cdot}5$, while 1, 14, 51 and $62\%$ of inoculum survived at pH $5{\cdot}0,\;5{\cdot}6\;and\;6{\cdot}5$, respectively. When tomato plants were inoculated with R. solanacearum through wounds on the stems, the bacteria moved downward from the inoculation site to the roots and infectious bacteria were released from the roots into the nutrient solution. Of two pH regimes tested in greenhouse nutrient-film technique(NFT) culture, the R. solanacearum population was significantly lower in pH 5.0 than in pH 6.5 in most sampling data. In treatments in which R. solanacearum was introduced by transplanting two root-inoculated plants, significantly move plants developed wilt at pH $6{\cdot}5$(34 out of 48 plants) than at pH 5.0(11 out of 48 plants). In addition, when the bacterium was introduced by transplanting two stem-inoculated plants at pH $6{\cdot}5$, seven out of 24 plants developed wilt.

• Research in Plant Disease
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• v.13 no.1
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• pp.34-39
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• 2007

Lichen thalli of Dirinaria applanata heavily colonized on the twigs of dead or dying Rhododendron trees in Solok island, Jeonnam province in Korea. Pathogenesis of the lichen on the trees was investigated to find out the possibility of lichen as a causal agent. Histological examination of the lichen colonized twigs was attempted with differential staining technique. Lichen-forming fungus colonized only on the surface of bark and there was no direct penetration of fungal hyphae into the plant tissues. Symbiotic algae of the lichen was also examined. The isolated algal cells were inoculated on artificially induced wounds of the healthy trees. Histological examination of the inoculated tissues showed that some algal cells were successfully colonized inside the tissues without any pathogenic symptoms, even 2 months later, The extract of the lichen thalli was also examined using 10% of DMSO solution. Treated tissues showed no pathogenic symptoms, even 4 weeks later. The results suggested that the lichen was not directly involved in the death of the trees.

• Research in Plant Disease
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• v.13 no.1
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• pp.57-60
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• 2007

A rhizopus soft rot caused by Rhizopus stolonifer occurred sporadically on grape in orchard in Gyeongsang-nam-do Agricultural Research and Extension Services and in Wholesale Market of Agricultural Products in Jinju city. The infected fruits were rapidly water-soaked, softened and eventually rotted, and the symptoms were initiated from wounds or cracks occurred at harvest time. Sporangiophores were $850{\sim}1,800{\mu}m$ in length and $12{\sim}23{\mu}m$ in width. Sporangia were globose or hemispheric and $80{\sim}190{\mu}m$ in size. The color of sporangia was white and cottony at first and gradually to brownish black, bearing abundant spores when it matured. Columella were hemispheric and $70{\sim}95{\mu}m$ in size. Sporangiospores were irregular round or oval, brownish-black streaked and $8{\sim}22{\times}6{\sim}10{\mu}m$ in size. The optimum temperature for mycelial growth of the fungus on PDA was 25$^{\circ}C$. On the basis of mycological characteristics and pathogenicity to grape (Vitis vinifera), the causal fungus was identified as Rhizopus stolonifer (Ehrenberg ex. Fr,) Lind. This is the first report of Rhizopus soft rot by R. stolonifer on grape (V. vinifera) in Korea.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.413-418
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• 2008

Purpose: When choosing dressing method to treat skin defect by second degree or higher burn, we have to consider method of rapid epithelization and minimization of pain during the treatment. In this study, we used biologic dressing with cultured allogenic keratinocytes for skin defect due to burn. We followed up the degree of epithelization, the degree of pain, and patient satisfaction. Methods: From June 2003 to June 2006, among the patients with skin defect due to burn, 31 cases with second degree burn(moderate to severe) were selected and biological dressing with cultured allogenic keratinocytes were done. 21 cases did not use cultured allogenic keratinocytes. Most of the patients had second degree burn. We applied cultured allogenic keratinocyte by Kaloderm. For wounds that were not deep enough to effect the dermis, escharectomy was done before applying Kaloderm. After the operation, moist wound site was maintained by dressing with saline gauze for 5 - 7 days. We compared the condition of the wound site before and after applying Keloderm by grading epithelization by standardized percentage scoring scale(1 - 5), and degree of pain and patient satisfaction by visual analogue scale(0 - 10). Results: When cultured allogenic keratinocytes were applied for the same period of time, the mean score of epithelization were $3.29{\pm}0.529$(mean ${\pm}$ S.D.). Without the application, the mean score of epithelization were $2.86{\pm}0.655$(mean ${\pm}$ S.D.). The degree of pain was $7.71{\pm}1.419$(mean ${\pm}$ S.D.) and $2.35{\pm}0.950$(mean ${\pm}$ S.D.) before and after the application, respectively. The patients' satisfaction score was $6.45{\pm}0.850$(mean ${\pm}$ S.D.) and $8.45{\pm}0.961$(mean ${\pm}$ S.D.) before and after the application, respectively. Conclusion: Applying biological dressing with cultured allogenic keratinocyte to skin defect due to second degree burn showed satisfactory results in the degree of the epithelization, degree of pain and patients' satisfaction.

• Journal of Trauma and Injury
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• v.27 no.4
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• pp.145-150
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• 2014

Purpose: To assess the accuracy and role of single-contrast computed tomography (CT) in the management of anterior abdominal stab wound (AASW). Methods: During 8-years period, single-contrast CT was performed in 21 hemodynamically stable AASW patients (age range, 22-64 years; median age, 45 years), including 19 men and 2 women. CT scans were evaluated by one trauma surgeon and one senior resident to determine the depth of injury(peritoneal violation or not), and abnormal findings of intraperitoneal cavity associated with stab injury. We retrospectively reviewed medical records regarding operative findings. Results: Nine patients underwent abdominal surgery and 12 patients nonoperative management. In the abdominal surgery group, abnormal CT findings included peritoneal violation in 14 patients and abnormal intraperitoneal cavity findings in 5 patients. There was no statistical significant difference regarding abnormal CT findings between abdominal surgery group and nonoperative management group. Among the nine abdominal surgery patients, therapeutic laparotomy was performed on 4 patients. The positive predictive value (PPV) and negative predictive value (NPV) of peritoneal violation to predictive therapeutic laparotomy were 28.6% and 100%, respectively. In addition, the PPV and NPV of abnormal intraperitoneal cavity CT findings to predict therapeutic laparotomy were 40.0% and 87.5%, respectively. There was no statistical significant difference regarding the abnormal CT findings between therapeutic laparotomy group and non therapeutic laparotomy group. Conclusion: CT is a good adjunctive method to evaluate hemodynamicaly stable AASW patients. If peritoneal violation is not seen on CT scan, conservative treatment on local wound may be safely performed without additional abdominal surgery. However, further study is warranted to evaluate the exact role of CT in the diagnostic workup of AASW patients.

• Journal of Chest Surgery
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• v.13 no.1
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• pp.60-65
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• 1980

We have experienced 2 cases of the hunshot wound sof the chest involving cardiac injuries at department of the thoracic surgery, Capital Armed Forces General Hospital during I year from April I 1979 to Jan. 1980. In one case of two patients , he was a 22 years old man who was transported to this emergency room 4 hour 10 minutes after having gunshot wound of the left chest by helicopter. Physical examination showed small inlet in left 3rd ICS and left parasternal border, large outlet in left 8th ICS and left scapular line, no breath sound on left side and distant heart sound. chest roentgenography demonstrated marked pleural effusion in left side and mediastinum shifted to right. As soon as chest X-ray was taken, the bleeding through penetrating wound became profuse and cardiac arrest ensued. Closed chest cardiac massage was started and vigorous transfusion continued, but no effective cardiac activity could not be obtained. The patient was pronounced dead due to exsanguinating hemorrhage from wuwpected cardiac wounds. In this critically injured patient with evidence of intrathoracic hemorrhage and suspected cardiac penetration, only emergency thoracic exploration and immediate surgical control of bleeding points might offer the maximum possibility of survival. The other case was a 23 years old man who was transferred to the emergency room 4 hours 50 minutes after having kmultiple communicated fractures of sternum and linear fracture of right mandible by a missile. Examination revealed about 30% skin loss of the anterior chest wall, weak pulse of 96 beats/min., distant heart sound and decreased breath sounds bilaterally. finding on the chest X-ray films showed multiple sternal fractures, marked pericardial effusion indicating hemopericardium. So, the patient was moved immediately to the operation room where, after endotracheal tube inserted, a median sternotomy was performced. A hemorrhagic congestion of the right upper lobe and marked bulging pericardium were disclosed. The pericardium was opened anterior to right phrenic nerve and exsanguinating hemorrhage ensued from the 0.5cm lacerated wound in the auricle of right atrium. The rupture site of right atrium was occluded with non-crushing vascular clamps and then was over sewn with interrupted sutures. It was thought to be highly possible that he was alive long enough to have cardiorrhaphy because of cardiac tamponade, which prevented exsanguinating hemorrhage. He was taken closed reduction for linear fracture of right mandible 2 weeks after repair of ruptured right auricle in dental clinic. This patient's post-operative course was not eventful.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.10 no.11
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• pp.3434-3443
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• 2009

This study was done to examine patients' wound care knowledge and concerns prior to discharge from a tertiary hospital. The participants in this descriptive survey were 112 patients having wounds. During interview, a structured self-administered questionnaire was filled out. The participants were 71 males and 41 females. Wound types were surgical incision (52.7%), percutaneous wound (26.8%), pressure ulcer (9.8%) and diabetic foot and arterial ulcers (5.4%). Their wound care knowledge was 52.0% of correct answer and the mean of concerns (range 1-7) was 2.79. There was no significant correlation between their knowledge and concerns of wound care. The factors influence on wound care concerns were fear of wound care, wound pain, length of hospital stays, and perceived health condition. This findings showed that discharge patients with a wound had some incorrect knowledge and various concerns about wound care. They may help to direct patient teaching in discharge plan.