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Experiences of Emergency Surgical Treatment for a COVID-19 Patient with Severe Traumatic Brain Injury at a Regional Trauma Center: A Case Report

  • Yun, Jung-Ho
    • Journal of Trauma and Injury
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    • v.34 no.3
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    • pp.212-217
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    • 2021
  • Various medical scenarios have arisen with the prolonged coronavirus disease 2019 (COVID-19) pandemic. In particular, the increasing number of asymptomatic COVID-19 patients has prompted reports of emergency surgical experiences with these patients at regional trauma centers. In this report, we describe an example. A 25-year-old male was admitted to the emergency room after a traffic accident. The patient presented with stuporous mentality, and his vital signs were in the normal range. Lacerations were observed in the left eyebrow area and preauricular area, with hemotympanum in the right ear. Brain computed tomography showed a contusional hemorrhage in the right frontal area and an epidural hematoma in the right temporal area with a compound, comminuted fracture and depressed skull bone. Surgical treatment was planned, and the patient was intubated to prepare for surgery. A blood transfusion was prepared, and a central venous catheter was secured. The initial COVID-19 test administered upon presentation to the emergency room had a positive result, and a confirmatory polymerase chain reaction (PCR) test was administered. The PCR test confirmed a positive result. Emergency surgical treatment was performed because the patient's consciousness gradually deteriorated. The risk of infection was high due to the open and unclean wounds in the skull and brain. We prepared and divided the COVID-19 surgical team, including the patient's transportation team, anesthesia team, and surgical preparation team, for successful surgery without any transmission or morbidity. The patient recovered consciousness after the operation, received close monitoring, and did not show any deterioration due to COVID-19.

Human Bites Over Nose: Management and Reconstruction

  • Kuldeep Singh;Krittika Aggarwal
    • Archives of Plastic Surgery
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    • v.50 no.2
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    • pp.171-176
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    • 2023
  • Background Human bite wounds in emergency department need evaluation in regard of reconstruction. These are due to occlusive bite injuries over face. Most commonly, human bites over face involve ear and nose, and may lead to avulsion injury. Defects over nose can be reconstructed immediately after debridement or delayed till the wound heals and scar becomes supple. Thorough wash and lavage with broadspectrum antibiotic cover has utmost importance in preventing cartilage infection. Methods We report 20 cases of human bite injuries over nose who presented to us in emergency department between 2018 and 2020. At the time of presentation the wound was assessed for closure. If not possible, patient was planned for delayed reconstruction after 3 months. In case delayed reconstruction was planned, the skin and nasal mucosa were approximated at first presentation. The patients underwent paramedian forehead flap after recreation of defect with conchal cartilage graft. Second stage of flap detachment and insetting was done after 3 weeks. After three weeks of second stage, third stage of flap thinning was done. Patients were followed for 3-6 months and subjective satisfaction was noted. Results Nineteen patients underwent delayed staged reconstruction with paramedian forehead flap and one underwent primary wound closure. The flap survival was 100%. The patient satisfaction was excellent in most cases. Conclusion We recommend delayed reconstruction for human bite nasal injuries. For reconstruction, paramedian forehead flap with conchal cartilage graft, if required, provides excellent reconstructive option with good contour and color match and minimal donor site scar.

Studies on the Cultural and Serological Tests of Mycoplasma Pulmonis in Laboratory Animal. (실험동물에 Mycoplasma Pulmonis의 배양 및 혈청학적 시험)

  • Kim Jae Yeon;Lee Yong Hee
    • Journal of environmental and Sanitary engineering
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    • v.1 no.1 s.1
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    • pp.69-79
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    • 1986
  • This studies were carried out to investigate the high infection sites from various specimens, cultural isolation on the susceptible media and specific antibody titres of M. pulmonis in experimental 310 mice and 330 rats obtained from two breeding facilities. Efficiency of complement faxation test (CF test) for detection of M. pulmonis antibody in mice and rats were compared directly with the diagnostic cultural isolation method. 1. Isolation rates of M. pulmonis among infection sites were about 30% from the oral cavities and $40\%$ from the middle ear of mice. The rates were $100\%$from the nasal cavaties and $90\%$ from the oral cavities of rats. 2. The infection rates were $12\%$ to A group and $16\%$ to B group of mice. The rates in the rats were $55\%$ to A group and $70\%$ to B group. 3. The M. pulmonis antibody titres by CF test were $73\%$ of total 100 mice in serum dilution below 1:5 (< 1:5), and $24\%$ of total samples in antibody titres above 1:5 (> 1:5), but 3 samples were not showed anticomplementary activities. The antibody titres in rats were $35\%$ of 120 rats in below 1:5 (< 1:5), and $61\%$ of total samples in above 1:5 (> 1:5), but the remained were not showed anticomplementary activities.

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Evaluaton of the Government Recommended Forage Cultivars in Korea III. Forage performance of corn hybrids (목초 및 사료작물 정부장려품종의 지역적응성 평가 III. 사일리지용 옥수수의 생육특성과 수량)

  • 김동암;최기춘;신정남;김종덕;한건준;김원호;조무환
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.17 no.4
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    • pp.315-322
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    • 1997
  • Sixteen cultivars of corn(Zea mays L.) hybrids have been recommended as the government recommended corn hybrids since 1984, however, their forage performances have been mostly tested at two locations, such as Suweon and Sunghwan in the Middle parts of Korea. Therefore, the objective of this experiment was to retest the agronomic characteristics and yield of eleven of sixteen government recommended corn hybrids at five scattered locations, such as Icheon, Suweon, Sunghwan, Keonpan and Kwangju in 1993 and 1995 with the intention of improving recommendations to dairy farmers. Among the corn hybrids tested, 'Suweon 19' was susceptible to foliar diseases and poor stay green at all locations in 1993 and 1995. Generally, all hybrids have less lodging and infection rate of rice black streaked dwarf virus(RBSDV) varied by location but mostly not exceed 10%. Infection rate at Sunghwan and Kwangju among locations was the highest as 13.5 and 15.3% respectively. Among the corn hybrids tested, 'Suweon 19' was the highest RBSDV infection rate, but that of 'Kwanganok' and '3282' was lower than other hybrids. At all locations, '3352' and '3394' were the earliest in growth stage, but 'Kwanganok', '3282', 'DK729', 'G4624' and 'DK713' were the latest among the corn hybrids. Ear percentage in total DM of '3352', '3394' and 'G4624' was higher than other hybrids, but that of 'DK713' was the lowest among the corn hybrids. '3352' and '3394' showed the most suitable DM content for silage production at harvest. Among the corn hybrids tested, 'Suweon 19' and '3282' were the lowest DM yield at all locations in 1993 and 1995, but the highest DM yield varied by location. At Icheon, '3144W' and 'G4743', at Suweon, '3352' and '3144W, at Sunghwan, 'DK729' and '3144W', at Keongsan, '3352' and 'DK729', and at Kwangju, '3352' and 'DK689' were the highest DM yield in 1993 and 1995, respectively. Then, '3394' was higher than other hybrids at all locations in 1995. The government recommended corn hybrids tested were generally adapted across the country. However, in forage production situations where wrn should be harvested before the rainy season in late summer, earlymedium maturing corn hybrids, '3352' and '3394' might be preferred.

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Beneficial Effect of Ginseng Extract on Sudden Sensorineural Hearing Loss (돌발성난청에서 홍삼추출물의 추가적인 치료효과)

  • Im, Gi-Jung;Cinn, Young-Gi;Chang, Ji-Won;Choi, Joan;Chae, Sung-Won;Jung, Hak-Hyun
    • Journal of Ginseng Research
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    • v.33 no.2
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    • pp.155-159
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    • 2009
  • Sudden idiopathic sensorineural hearing loss is a disease that develops within several hours to several days. Its etiology has not yet been verified, but the disturbance of the circulation of blood in the inner ear, inner-ear hydrops, and viral infection are considered possible causes of the disease. This study was conducted to evaluate the effect of Panax ginseng extract, which is known to have a vasodilatory effect, on sudden sensorineural hearing loss. Sixty-nine patients suffering from sudden sensorineural hearing loss were admitted to Korea University Anam Hospital from March to December 2008. They were divided into the experimental (30 ears) and control (39 ears) groups. Ginseng extract (2700 mg/day, 4 weeks) was added to the therapeutic regimen in the experimental group. The effect of ginseng extract therapy was analyzed according to the factors relating to the prognosis. A considerable hearing improvement was documented in both groups (32.2 dB in the experimental group and 25.8 dB in the control group). However, there was little beneficial effect of ginseng extract on additional hearing improvement compared with control. The total recovery rate of the experimental group (80.0%) was better than that of the control group (58.9%), and the experimental group's high-tone hearing gain at 3 kHz (29.7 dB) was better than that of the control group (21.7 dB). The results of the study suggest that the effects of ginseng therapy tend to be superior to those of the conventional therapy, but the difference between the two is not statistically significant. The hearing gains tend to be in the higher frequencies and may be due to the promotion of cellular differentiation from the supporting cells.

Epidural Abscess Caused by Eikenella corrodens in a Previously Healthy Child

  • Kim, Ye Kyung;Han, Mi Seon;Yang, Song I;Yun, Ki Wook;Han, Doo Hee;Kim, Jae Yoon;Choi, Eun Hwa
    • Pediatric Infection and Vaccine
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    • v.26 no.2
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    • pp.112-117
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    • 2019
  • Eikenella corrodens rarely causes invasive head and neck infections in immunocompetent children. We report a case of epidural abscess caused by E. corrodens in a previously healthy 13-year-old boy who presented with fever, headache, and vomiting. On physical examination upon admission, there was no neck stiffness, but discharge from the right ear was observed. Brain magnetic resonance imaging (MRI) revealed approximately 4.5-cm-sized epidural empyema on the right temporal lobe as well as bilateral ethmoid and sphenoid sinusitis, right mastoiditis, and right otitis media. During treatment with vancomycin and cefotaxime, purulent ear discharge aggravated, and on follow-up brain MRI, the empyema size increased to $5.6{\times}3.4cm$ with interval development of an abscess at the right sphenoid sinus. Burr hole trephination was performed, and foul-smelling pus was aspirated from the epidural abscess near the right temporal lobe. Pus culture yielded E. corrodens. Endoscopic sphenoidotomy was also performed with massive pus drainage, and the same organism was grown. The patient was treated with intravenous cefotaxime for 3 weeks and recovered well with no other complications. Therefore, E. corrodens can cause serious complications in children with untreated sinusitis.

A study on the degree of need of the knowledge of pathophysiology, clinical microbiology and mechanisms and effects of drugs in clinical nurses (기초간호자연과학의 병태생리학, 병원미생물, 약물의 기전과 효과 내용별 필요도에 대한 연구)

  • Choe, Myoung-Ae;Byun, Young-Soon;Seo, Young-Sook;Hwang, Ae-Ran;Kim, Hee-Seung;Hong, Hae-Sook;Park, Mi-Jung;Choi, S-Mi;Lee, Kyung-Sook;Seo, Wha-Sook;Shin, Gi-Soo
    • Journal of Korean Biological Nursing Science
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    • v.2 no.1
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    • pp.1-19
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    • 2000
  • The purpose of this study was to define the content of the requisite knowledge of pathophysiology, clinical microbiology, and mechanisms and effects of drugs needed for clinical knowledge for nursing practice. Contents of knowlege on pathological physiology, clinical microbiology, and mechanisms and effects of drugs were constructed from syllabus of basic nursing subjects in 4 colleges of nursing, and textbooks. The degree of need of 72 items was measured with a 4 point scale. The subjects of this study were college-graduated 136 nurses from seven university hospital in Seoul and three in Chonnam Province, Kyungbook Province, and Inchon. They have been working at internal medicine ward, surgical ward, intensive care unit, obstetrics and gynecology ward, pediatrics ward, opthalmology ward, ear, nose, and throat ward, emergency room, rehabilitation ward, cancer ward, and hospice ward. The results were as follows : 1. The highest scored items of the knowledge of pathophysiology, clinical microbiology, and mechanisms and effects of drugs necessary for nursing practice were side effects of drugs, anticoagulants, mechanisms of drugs, antihypertensive drugs, tolerance and addiction of drugs, interactions among drugs, hospital infection in the order of importance. The lowest scored item was structure of microorganisms. 2. The highest order of need according to unit was repair in tissue injury unit, definition etiology classification of inflammation in inflammation unit, transplantation and immunologic response in alterations in immunity unit, thrombus and thrombosis in disorders of cardiovascular function unit, gene disorders in genetic disorders unit, hospital infection in infection unit, virus in microorganisms unit, side reactions of drugs in introduction unit, anticonvulsants in drugs for central nervous system unit, local anesthesia in anesthesia unit, anticoagulants in drugs for cardiovascular system unit, anti-inflammatory drugs in antibiotics unit, anti-ulcer drugs in drugs for digestive system unit, and bronchodilators in drugs for respiratory system unit. 3. The common content of the knowledge of pathophysiology, clinical microbiology, and mechanisms and effects of drugs needed for all clinical areas in nursing were side effects of drugs, anticoagulants, interactions among drugs, and hospital infection. However, the degree of need of each pathological physiology, clinical microbiology, clinical microbiology, and mechanisms and effects of drugs was different depending on clinical areas. 4. Significant differences in the knowledge of pathophysiology, clinical microbiology, and mechanisms and effects of drugs necessary for nursing practice such as tissue changes due to injurious stimuli, degenerative changes of tissue, alterations in metabolism of carbohydrates, ischemia, hyperemia and congestion, hospital infection, structure of microorganism, classification of microorganism, bacteria, virus, antidepressants, antipsychotic drugs, antiemetic drugs, antiparkinsonism drugs, antianxiety drugs, antibiotics, tuberculostatics, antiviral drugs, antifungal drugs, parasiticides, antiulcer drugs, antidiarrheais, and anti constipation drugs were shown according to the work area. 5. Significant differences in the knowledge of pathophysiology, clinical microbiology, and mechanisms and effects of drugs necessary for nursing practice such as transplantation and immunologic response, alterations in the metabolism of uric acid, structure of microorganism, classification of microorganism, immunosuppressants, drugs for congestive heart failure were demonstrated according to the duration of work. Based on these findings, all the 72 items constructed by Korean Academic Society of Basic Nursing science should be included as contents of the knowledge of pathophysiology, clinical microbiology, and mechanisms and effects of drugs.

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Immune Reaction to Infection by Malassezia pachydercatis in Canine Ezternal Ear Canals (개 외이도내 Malassezia pachydercatis 감염에 대한 면역 반응)

  • 이진희;오태호;한홍율;조상내
    • Journal of Veterinary Clinics
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    • v.13 no.2
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    • pp.130-139
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    • 1996
  • Malassezia pachydercatis균은 개 외이염의 주된 원인균으로 알려져 있으나, 그 감염률은 지역에 따라 많은 차이가 있다. 그러나 그 기병론적인 역할에 대해서는 아직 명확히 밝혀지지 않았다. 이에 본문에서는 국내에서 사육되는 개의 외이염에서 Malassezia pachydercatis 균의 분리율을 조사하고, Malassezia pachydercatis에 대한 혈중 항체와 외이염과의 연관성을 밝혀 Malassezia pachydercatis에 의한 외이염 진단을 위한 도구로서 간접 ELISA 법의 유용성을 평가해 보고자 본 연구를 수행하였다. 총 112두 중, 외이염에 감염된 개 44두와 정상견 68두를 대상으로, 심부외이도에서 취한 가검물을 배양검사하였고, Malassezia pachydercatis 항원에 대한 혈청내 IgG와 IgM 역가를 간접 ELISA법에 의해 측정하였다. 살아있는 Malassezia pachydercatis 균을 3두의 정상견 외이도에 접종하여 Malassezia pachydercatis 균의 실험적 감염에 대한 조직병리학적 소견, 조직내 침투 정도, 그리고 접종 후 시간경과에 따른 IgG와 IgM의 혈중 역가변화를 측정하였다. Malassezia pachydercatis 균은 외이염이 있는 개 귀에서 가장 높게 분리(50.0%)되었고, 정상귀에서는 낮게 분리(6.3%)되었다. Malassezia pachydercatis 항원을 이용한 간접 ELISA 법 진단에서, Malassezia pachydercatis 양성배양인 외이염 개체에서 IgG와 IgM에 대한 민감도는 각각 41.7%, 20.8%이었고 특이도는 88.2%, 85.2% 이었다. 실험적으로 Malassezia pachydercatis 를 접종한 3두중 1두에서만 조직병리학적 변화와 모낭에 Malassezia pachydercatis 균체가 확인되었으며, IgG와 IgM 혈중역가도 유의성 있게 증가하였다. 국내에서 사육되는 개 외이염의 주된 원인균은 Malassezia pachydercatis 균이었고 이 균의 혈중항체는 유의성 있게 증가하였으며(p<0.005), 간접 ELISA법은 Malassezia pachydercatis 에 의한 개외이염의 유용한 진단도구임을 증명하였다.

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Caprine Dermatitis Caused by Trichophyton mentagrophytes (Trichophyton mentagrophytes에 의한 염소의 피부염)

  • Pal Mahendra;Sukumaran K.;Sejra Anand Ram;Lee Chang Woo
    • Journal of Veterinary Clinics
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    • v.8 no.2
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    • pp.147-152
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    • 1991
  • Trichophyton mentagrophytes was described as a primary cause of mycotic dermatitis in two young goats housed together in a humid, ill-ventilated and unhygienic byre. The diagnosis in both the cases was established on the detection of fungal element in the skin scrapings by potassium hydroxide technique and isolation of the pathogen in pure growth on mycological medium at 30$^{\circ}C$. The lesions were found on the face of one kid and on the neck and ear of another one. Two adult goats housed in the same enclosure were found to be free from this disease. Further, there was no evidence of ringworm in the goat owner and his family members. Genetic crossing of both the isolates on modified sunflower seed medium indicated that they belonged to (―) mating type. Hair performation test revealed the keratolytic activity of both the strains of T. mentagrophytes. The public health significance and chemotherapy are also discussed. The question of source of infection could not be emphatically established.

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The Clinical Experiences of Congenital Preauricular Fistulectomy including Cartilage Excision (연골절제를 병행한 선천성 이루의 치료 경험)

  • Park, Jang Woo;Kim, Mi Sun;Kim, Ho Kil;Choi, Hwan Jun;Lee, Young Mann
    • Archives of Plastic Surgery
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    • v.33 no.3
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    • pp.313-318
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    • 2006
  • The preauricular fistula is a congenital malformation of the ear with a small opening in the preauricular area. In general, this malformation should be treated by excision after its infection is brought under control with antibiotics. For cosmetic consideration, we performed a elliptic incision around opening, and then we dissected along the fistula tract to the cyst without sacrificing too much soft tissues. From March 2001 to March 2005, 90 patients with 102 cases of fistulas were excised including a small portion of auricular perichondrium and cartilage, where they adhered closely. Then, histologic findings of preauricular fistula were studied. The histologic findings reveal that the fistular tract is very close to auricular cartilage, and the thickness of fistular epithelium and perichondrium are about the same. There was no specific complications related to this procedure. The recurrence rate for the excision with cartilage was 2 out of 102(2%). Results of surgery in all cases were satisfactory. It is important, in preauricular fistular excision, perichondrium and auricular cartilage should be excised to prevent recurrence.