• Journal of Korean Neurosurgical Society
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• v.63 no.5
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• pp.649-656
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• 2020

Objective : Unclear mental state is one of the major factors contributing to diagnostic failure of occult skeletal trauma in patients with traumatic brain injury (TBI). The aim of this study was to evaluate the overlooked co-occurring skeletal trauma through whole body bone scan (WBBS) in TBI. Methods : A retrospective study of 547 TBI patients admitted between 2015 and 2017 was performed to investigate their cooccurring skeletal injuries detected by WBBS. The patients were divided into three groups based on the timing of suspecting skeletal trauma confirmed : 1) before WBBS (pre-WBBS); 2) after the routine WBBS (post-WBBS) with good mental state and no initial musculoskeletal complaints; and 3) after the routine WBBS with poor mental state (poor MS). The skeletal trauma detected by WBBS was classified into six skeletal categories : spine, upper and lower extremities, pelvis, chest wall, and clavicles. The skeletal injuries identified by WBBS were confirmed to be simple contusion or fractures by other imaging modalities such as X-ray or computed tomography (CT) scans. Of the six categorizations of skeletal trauma detected as hot uptake lesions in WBBS, the lesions of spine, upper and lower extremities were further statistically analyzed to calculate the incidence rates of actual fractures (AF) and actual surgery (AS) cases over the total number of hot uptake lesions in WBBS. Results : Of 547 patients with TBI, 112 patients (20.4 %) were presented with TBI alone. Four hundred and thirty-five patients with TBI had co-occurring skeletal injuries confirmed by WBBS. The incidences were as follows : chest wall (27.4%), spine (22.9%), lower extremities (20.2%), upper extremities (13.5%), pelvis (9.4%), and clavicles (6.3%). It is notable that relatively larger number of positive hot uptakes were observed in the groups of post-WBBS and poor MS. The percentage of post-WBBS group over the total hot uptake lesions in upper and lower extremities, and spines were 51.0%, 43.8%, and 41.7%, respectively, while their percentages of AS were 2.73%, 1.1%, and 0%, respectively. The percentages of poor MS group in the upper and lower extremities, and spines were 10.4%, 17.4%, and 7.8%, respectively, while their percentages of AS were 26.7%, 14.2%, and 11.1%, respectively. There was a statistical difference in the percentage of AS between the groups of post-WBBS and poor MS (p=0.000). Conclusion : WBBS is a potential diagnostic tool in understanding the skeletal conditions of patients with head injuries which may be undetected during the initial assessment.

• Archives of Plastic Surgery
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• v.46 no.3
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• pp.198-203
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• 2019

Background Professional affiliation between medical centers and professional sports teams can be mutually beneficial in the provision of healthcare and marketing strategy. Anecdotal evidence suggests a link between trauma volume and sporting events; however, there is limited data. This study aims to characterize the incidence of operative hand and facial trauma during professional baseball home games. Methods A retrospective review of surgical cases for traumatic hand or facial injuries at a level 1 center between 1999 and 2012 was performed. Demographic information including date of injury, admission status, and operative repair were collected. Patients were grouped based on whether their trauma occurred on the date of a home game. Results Operative hand and facial trauma occurred at a rate of 33.4 injuries per 100 days with home games, compared to 22.2 injuries per 100 days (incidence rate ratios, 1.50; 95% confidence interval, 1.34-1.69). When home games were played, patients were more likely to present as a result of motorcycle accidents (3.1% vs. 1.5%; P=0.04) or bicycle accidents (5.0% vs. 2.6%; P=0.01). Other mechanisms of trauma were not statistically different. There was an increase incidence of injuries during home games in August; weekly variability showed an increased incidence during the weekends. Conclusions There was an increased rate of operative hand and facial injuries on dates with professional home games. The incidence of injuries during home games was higher in the late summer and on the weekends. Further analysis may allow improved resource allocation and strategies for injury prevention and treatment.

• Journal of Chest Surgery
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• v.56 no.2
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• pp.120-125
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• 2023

Background: Multiple rib fractures are common in blunt chest trauma. Until recently, most surgical rib fixations for multiple rib fractures were performed via open thoracotomy. However, due to the invasive nature of tissue dissection and the resulting large wound, an alternative endoscopic approach has emerged that minimizes the postoperative complications caused by the manipulation of injured tissue and lung during an open thoracotomy. Methods: Our study concentrated on patients with multiple rib fractures who underwent surgical stabilization of rib fractures (SSRF) between June 2018 and May 2020. We found 27 patients who underwent SSRF using video-assisted thoracoscopic surgery. The study design was a retrospective review of the patients' charts and surgical records. Results: No intraoperative events or procedure-related deaths occurred. Implant-related irritation occurred in 4 patients, and 1 death resulted from concomitant trauma. The average hospital stay was 30.2±20.1 days, and ventilators were used for 12 of the 22 patients admitted to the intensive care unit. None of the patients experienced major pulmonary complications such as pneumonia or acute respiratory distress syndrome. Conclusion: Minimally invasive rib stabilization surgery with the assistance of a thoracoscope is expected to become more widely used in patients with multiple rib fractures. This method will also assist patients in a quick recovery.

• Journal of Korean Dental Science
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• v.8 no.1
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• pp.10-15
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• 2015

Purpose: The aim of the present study is to assess the importance of proper treatment timing for dental emergency patients by characterizing current patient care in the emergency room. Materials and Methods: A retrospective chart review of 3,211 patients who visited the Chosun University Hospital's dental emergency department (Gwangju, Korea) was conducted from January 1, 2011 to May 31, 2014. Information regarding age, gender, onset date, main causes, and diagnoses were collected and analyzed. The main causes were divided into six categories: assault, household/play, sports, traffic, work, and others. Result: Emergency visits were more common for men (69%), and the ratio of males to females was 2.2:1 On average, the major cause was household/play (49.8%), followed by others (18.9%), traffic (16.6%), assault (9.1%), sports (2.9%), and work (2.6%). The most frequent diagnosis on average was dental trauma with 82.4%, followed by infection (10.7%), others (4.7%), and bleeding (2.2%). Conclusion: The main reasons for visits to the dental emergency department are dental trauma, dental infection, bleeding, and others. The most frequent reason for dental emergency patients to visit the emergency department was dental trauma (82.4%).

• Journal of Trauma and Injury
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• v.32 no.1
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• pp.26-31
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• 2019

Purpose: Rhabdomyolysis (RB) is a syndrome characterized by the decomposition of striated muscles and leakage of their contents into the bloodstream. Acute kidney injury (AKI) is the most significant and serious complication of RB and is a major cause of mortality in patients with RB. Severe RB (creatine kinase [CK] ${\geq}5,000$) has been associated with AKI. However, early prediction is difficult because CK can reach peak levels 1-3 days after the trauma. Hence, the aim of our study was to identify predictors of severe RB using initial patient information and parameters. Methods: We retrospectively analyzed 1,023 blunt trauma patients admitted to a single tertiary hospital between August 2011 and March 2018. Patients with previously diagnosed chronic kidney disease were excluded from the study. RB and severe RB were defined as a CK level ${\geq}1,000U/L$ and ${\geq}5,000U/L$, respectively. The diagnosis of AKI was based on RIFLE criteria. Results: The overall incidence of RB and severe RB was 31.3% (n=320) and 6.2% (n=63), respectively. On multivariable analysis, male sex (odds ratio [OR] 3.78, 95% confidence interval [CI] 1.43 to 10.00), initial base excess (OR 0.85, 95% CI 0.80 to 0.90), initial CK (OR 2.07, 95% CI 1.67 to 2.57), and extremity abbreviated injury scale score (OR 1.78, 95% CI 1.39 to 2.29) were found to predict severe RB. The results of receiver operating characteristic analysis showed that the best cutoff value for the initial serum CK level predictive of severe RB was 1,494 U/L. Conclusions: Male patients with severe extremity injuries, low base excess, and initial CK level >1,500 U/L should receive vigorous fluid resuscitation.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.65-70
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• 1987

Empyema thoracis following pneumonia, pulmonary tuberculosis, trauma and surgical procedures continues to be a source of major morbidity and mortality. We retrospectively reviewed the hospital records of 330 patients [child:87, adult243] treated for empyema thoracis at Catholic Medical Center between 1964 and 1986. The causes of empyema in these patients were as follows: pneumonia [C***:66%, A***:30%], pulmonary tuberculosis [C:2%, A:20%], lung abscess [C:3%, A:5%], postoperative complication [C:0%, A:13%], trauma [C:1%, A:4%] and unknown origin [C:23%, A:17%]. Three patients in this series died of sepsis from necrotizing pneumonia. Staphylococcus [29.3%], Streptococcus [8.8%], E. coli [8%], Mycobacterium tuberculosis [7.9%], Klebsiella [7.4%], Pseudomonas [6.4%], Bacteroides [3.4%] were the organisms most commonly isolated. Bacterial isolates were single in 68.3%, multiple 7.5% and absent 24.2%. The type of organism did not correlate with severity of disease or eventual requirement for closed thoracotomy drainage, open thoracotomy drainage [Modified Eloesser*s procedure], thoracoplasty, decortication or pleuropneumonectomy. Successful methods of treatment included aspiration in 44%, tube thoracotomy in 66%, open thoracotomy drainage in 98.7%, thoracoplasty in 98%, decortication in 96% and pleuropneumonectomy in 73%. Initial mode of management in empyema thoracis are thoracentesis and closed thoracotomy drainage. If the initial management was failed, we performed another surgical procedures. Before 1973, we manage with Schede`s thoracoplasty in the postpneumonectomy empyema patients. But thoracoplasty, with or without the use of muscle flaps, is a hazardous operation in the poor-risk patients. The permanent, open thoracotomy drainage is a relatively minor operation which is well tolerated even by cachexic, septic patients. It controls infection, and sometimes results in the bronchopleural fistula closing spontaneously.

• Journal of Trauma and Injury
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• v.24 no.2
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• pp.68-74
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• 2011

Purpose: Although pancreas injury is rare in abdominal trauma, it poses a challenge to the surgeon because its clinical features are not prominent and the presence of main duct injury cannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury. Methods: For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosed as having pancreas injury by using an explo-laparotomy. Patients successfully treated by non-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared. Results: Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases).Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due to massive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively, three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery. Conclusion: All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverse outcomes.

• Archives of Plastic Surgery
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• v.48 no.2
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• pp.231-236
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• 2021

Mucormycosis is an invasive, rapidly progressive, life-threatening fungal infection, with a propensity for diabetic, immunosuppressed, and trauma patients. The classic rhinocerebral variation is most common in diabetic patients. While the cutaneous form is usually caused by direct inoculation in immunocompetent patients. Cutaneous mucormycosis manifests in soft tissue and risks involvement of underlying structures. Tibial osteomyelitis can also occur secondary to cutaneous mucormycosis but is rare. Limb salvage is typically successful after lower extremity cutaneous mucormycosis even when the bone is involved. Herein, we report two cases of lower extremity cutaneous mucormycosis in diabetic patients that presented as acute worsening of chronic pretibial ulcers. Despite aggressive antifungal therapy and surgical debridement, both ultimately required amputation. Such aggressive presentation has not been reported in the absence of major penetrating trauma, recent surgery, or burns.

• Journal of Trauma and Injury
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• v.20 no.2
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• pp.125-129
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• 2007

Purpose: The liver is one of the most commonly injured organs in abdominal trauma. Surgery has played a major role in treating traumatic liver injury. Recently, it was reported that conservative treatment could be the first-line management for hemodynamically stable patients without combined intraabdominal surgical problems. The aim of this study was to examine the prognostic factors in traumatic liver injury. Methods: The medical records of 41 patients who were treated for traumatic liver injury at Seoul National University Bundang Hospital from March 2003 to October 2007 were retrospectively reviewed. Results: Among the 41 patients, 34 cases (82.9%) were managed nonsurgically, and 7 cases (17.1%) were managed surgically. Out of the 5 (12.2%) mortalities, 2 were encountered in those who underwent surgery, and 3 were encountered in those who were treated nonsurgically. Univariate analysis showed that the initial systolic blood pressure, the initial hemoglobin level, and the grade of liver injury were significant prognostic factors for survival. Multivariate analysis indicated that initial low systolic blood pressure was the only independent risk factor. Conclusion: Patients with unstable vital signs initially have a poor prognosis. Aggressive management might be helpful for improving the survival rate in these patients.

• Journal of Trauma and Injury
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• v.36 no.4
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• pp.393-398
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• 2023

Patients transported from fire sites may exhibit various injury patterns. Major trauma, skin burn, inhalation burn, and carbon monoxide poisoning are typical injuries. However, most physicians may be unfamiliar that cyanide poisoning can frequently occur due to combustion. Cyanide poisoning is highly significant owing to high mortality and the existence of antidotes. I present a 35-year-old man who was transported from a burning building and suffered severe metabolic acidosis despite no major bleeding as well as mild carbon monoxide poisoning. I suspected cyanide poisoning and administered the antidote; subsequently, the patient showed improvement. The next day, sudden airway obstruction developed, and emergency endotracheal intubation was performed. The inhalation damage was detected only in the lower airway tract and not in the upper airway. Physicians should be aware of cyanide poisoning and inhalation burn to avoid missing treatment opportunities.