• Title/Summary/Keyword: open fracture

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The Effect of a Chest CT Scan on the Treatment and Diagnosis of Major Blunt Chest Trauma (흉부 둔상환자에서 흉부전산화단층촬영이 진단과 치료에 미치는 영향)

  • Park, Il-Hwan;Oh, Joong-Hwan;Lee, Chong-Kook
    • Journal of Chest Surgery
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    • v.42 no.2
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    • pp.226-232
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    • 2009
  • Background: Blunt chest trauma accounts for 90% of all chest traumas in Europe and the United States and this causes 20% of all trauma-related deaths. The major cause of morbidity and mortality after blunt chest trauma is undetected injuries. For this reason, chest computerized tomography has gained popularity for the evaluation of trauma, but it is expensive and it exposes patients to radiation. This study identified the clinical features associated with the diagnosic information obtained on a CT chest scan, as compared with a standard chest X-ray, for patients who sustained blunt trauma to the chest. This study also evaluated the role of a routine computed tomographic (CT) scan for these patients. The patients who had chest computed tomography done after the initial chest x-ray were analyzed separately for the presence of occult injuries. Material and Method: We studied 100 consecutive patients from November 2006 to July 2007: 74 patients after motor vehicle crashes and 26 patients after a fall from a height >2m. Simultaneous with the initial clinical evaluation, an anteroposterior chest radiograph and a helical chest CT scan were obtained for all the patients. The data extracted from the medical record included the vital signs, the interventions and the type and severity of injury (RTS). Result: Among the 100 cases, 79 patients showed at least more than one pathologic sign on their chest radiograph, and 21 patients had a normal chest radiograph. For 17 of the patients who had a normal chest X ray, the CT scan showed multiple injuries, which were pneumothorax, hemothorax, lung contusion, sternal fracture etc. This represents that a CT scan is statistically superior to a chest radiograph to diagnose the pathologic signs. But on the other hand, as for treatment, only 31 patients were diagnosed by CT scan and they were treated with chest tube insertion ect. 42 patients needed ony conservative management without invasive thoracosurgical treatment such as chest tube insertion or open thoracotomy. 27 patients were treated based on the diagnosis made by the chest radiograph and physical examination. Conclusion: Chest computerized tomography was significantly more effective than routine chest X-ray for detecting lung contusion, pneumothorax and mediastinal hematoma, as well as fractured ribs, scapula and, sternum. Although the occult findings increased, the number of patients who needed treatment was small. Therefore, we suggest making selective use of a CT scan to avoid its overuse in ERs.

The Contents and Satisfation of Home Care Progral Delivered by Seoul Nurses Association (서울시 간호사회 가정간호시범사업 서비스 내용 및 만족도 분석)

  • Lim, Nan-Young;Kim, Keum-Soon;Kim, Young-lm;Kim, Kwuy-Bun;Kim, Si-Hyun;Park, Ho-Ran
    • The Korean Nurse
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    • v.36 no.1
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    • pp.59-76
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    • 1997
  • The purposes of this study were to identify the contents and satisfaction level of the patients received home care service, and to compare the differences of the contents by the characteristics of the patients. Seventy eight patients received home care service from 1st Jan. to 30th Sept., 1996 were data-collected to analyze the contents and outcomes of home care service. Sixty-nine patients currently receiving home care service were participated to evaluate the satisfaction level of home care service. The data were analyzed using mean, standard deviation, $x^2$ test, and ANOVA by SPSS $PC^+$ program. The findings of this study were as follow : 1. The contents & outcomes of home care service 1) The mean age of the subjects was 64.4 years: 58% of them were female. Those who living in Seoul were 83% and the rest of the subjects was living in Kyung-Gi. 2) The subjects who had one diagnosis were 41%. Over 60% of them had the disease of neurologic & sensory system. 3) The mean number of visit was 6. Only one visit was 22%. The mean time of care was 79 minutes. Duration of visit from 31 minutes to 60 minutes were 47 %. The subjects who terminated the visit because of death were 67.3%. 62% of the persons who referred them to the home care service were nurses. 4) The pain after the service was more relieved than before. The amounts of intake, the degree of bed sore, edema & fracture after the service were more improved than before. Health status after the service was improved in general. 5) There were significant differences between initial and last conscious level in tracheostomy care & oxygen inhalation care. There was significant difference between initial and last degree of activity in blood sugar check. 6) There were significant differences on the number of visit in assessment of the status, evaluation & observation, vital sign check, skin care, injection, medication, bed sore care, colostomy care, relaxation therapy for pain relief, patient education, family care, exercise therapy, position change, supply of disinfected equipments and infection control. There were significant differences on visiting time in nasogastric tube care, drainage tube care and oxygen inhalation care. 2. The satisfaction level of home care service 1) 50% were male. Over 60 years of the subjects was 61 %. Those who living in Seoul were 82%. 2) The subjects who had one or two diagnosis were 32% respectively. 55% of the persons who referred them to the home care service were nurses. 3) Total level of satisfaction of home care service was very high. 4) The older the age, the higher the satisfaction level. The larger the number of visit, the higher the satisfaction level. 5) The subjects who were in cloudy state were higher level of satisfaction than in alert or coma state. The subjects whose activity were normal or who needed assistance were higher level of satisfaction than bedridden or immobilized subjects. These findings suggested that the patients had substantial need for posthospital care. They tended to be elderly and to have experienced the wide range of health problems associated with aging, chronicity, including limitations in activities, and other serious health problems. So, the nationwide home care systems beyond the limit of demonstration program by local association and the development of the effective financial system of home based health care are necessary for the clients who are in need of home care.

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Deterioration Diagnosis and Source Area of Rock Properties at the West Stone Pagoda, Gameunsaji Temple Site, Korea (감은사지 서탑의 풍화훼손도 진단 및 석재의 산지추정)

  • Lee Chan Hee;Lee Myeong Seong;Suh Mancheol;Choi Seok-Won;Kim Man Gap
    • Economic and Environmental Geology
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    • v.37 no.5
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    • pp.569-583
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    • 2004
  • The rock properties of the West pagoda in the Gameunsaji temple site are composed mainly of dark grey porphyritic granodiorite with medium grained equigranular texture and developed with small numerous dioritic xenoliths. These xenoliths occurred with small holes due to different weathering processes. As a weathering results, the rock properties of this pagoda occur wholly softened to physical hardness because of a complex result of petrological, meteorological and biological causes. Southeastern part of the pagoda deteriorated seriously that the surface of rock blocks showed partially exfoliations, fractures, open cavities in course of granular decomposition of minerals, sea water spray and crystallization of salt from the eastern coast. The Joint between blocks has small or large fracture cross each other, contaminated and corrupted for inserting with concrete, cement mortar, rock fragments and iron plates, and partially accelerated coloration and fractures. There are serious contamination materials of algae, fungus, lichen and bryophytes on the margin and the surface on the roof stone of the pagoda, so it'll require conservation treatment biochemically for releasing vegetation inhabiting on the surface and the discontinuous plane of the blocks because of adding the weathering activity of stones and growing weeds naturally by soil processing on the fissure zone. Consisting rock for the conservation and restoration of the pagoda would be careful choice of new rock properties and epoxy to reinforce for the deterioration surfaces. For the attenuation of secondary contamination and surface humidity, the possible conservation treatments are needed.

Revaluation of Ore Deposits within the Yeongam District, Cheollanamdo-Province: The Eunjeok and Sangeun Mines (전남 영암지역 광상 재평가: 은적.상은 광산를 중심으로)

  • Heo, Chul-Ho;Park, Sung-Won;Lee, Jae-Ho
    • Economic and Environmental Geology
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    • v.43 no.2
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    • pp.73-84
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    • 2010
  • Gold and silver deposits within the Eunjeok and Sangeun mines are located in Yeongam district, Cheollanamdo-province. They are composed of vein ore bodies infilling the fractures of Cretaceous rhyolitic tuff. The Eunjeok mine have three gold and silver bearing hydrothermal veins which is infilling the fracture of rhyolitic tuff. Major ore minerals within the Eunjeok and Sangeun mines are arsenopyrite, pyrite, chalcopyrite, sphalerite and galena and minor ores are electrum, native silver and argentite. Sericitization is dominant in alteration zone and chloritization and dickitization is minor. Quartz veins in the Eunjeok and Sangeun mine have the similar paragenesis and vein textures such like breccia, crustiform, comb and vuggy morphology indicating the formation of typical epithermal environment. In order to carry out the preliminary feasibility study of mine according to the commodity and elucidate the occurrence features of mineral resources from Eunjeok and Sangeun mine, common commodity (Pb, Zn, Cu, Fe, Mo, W, Au and U), and industrial commodity (In, Re, Ga, Ge, Se, Te, Y, Eu and Sm) for 17 ore specimen were analyzed. It is tentatively thought that there is no exploitable mine for iron, lead, zinc, copper, tungsten and uranium based on the preliminary result. If the reserves are secured through the detailed prospecting in case of molybdenum and silver, it is tentatively thought that there will be exploitable deposits depending on international metal price. If we assume the vein width from 0.25 m to 2 m including alteration zone with the gold grade of 80g/t, it is inferred that the resources amount of the Eunjeok-Sangeun mines range from 6.5 to 65ton. However, as the vein structure of the Eunjeok and Sangeun mines is developed together with alteration zone, it should be estimated to include potential alteration zone in order to yield the average grade. It is needed to carry out more exploration in the near future because the reserves can be flexibly estimated according to the change of average grade considering the alteration zone.

Ore Mineralization of The Copper-bearing Hanae Hydrothermal Vein Deposit (하내 함 동 열수 맥상광상의 광화작용)

  • Choi, Sang-Hoon;Lee, Sunjin;Jun, Youngshik
    • Economic and Environmental Geology
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    • v.50 no.6
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    • pp.435-443
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    • 2017
  • The Hanae deposit is located within the Cretaceous Gyeongsang Basin. The Cu-bearing hydrothermal quartz vein formed by narrow open-space filling along fracture in the sedimentary rocks as Jindong Formation. The Hanae Cu-bearing hydrothermal deposit shows a paragenetic sequence of pyrrhotite-pyrite $\rightarrow$ pyrite-chalcopyrite-sphalerite(${\pm}$Bi-bearing tellurides) $\rightarrow$ Ag-bearing telluride mineralization $\rightarrow$ secondary mineralization. Fluid inclusion data indicate that the Hanae Cu-bearing hydrothermal mineralization occurred from dominantly aqueous fluids at temperatures of $400^{\circ}C-200^{\circ}C$. Equilibrium thermodynamic interpretation of the mineral paragenesis and assemblages combined with fluid inclusion data indicate that early main Cu-bearing ore mineralization in the vein starts at about $350^{\circ}C$ which corresponds to sulfur fugacity from about $10^{-9.2}$ to $10^{-8.7}bar$ with oxygen fugacity of about $10^{-32.1}$ to $10^{-29.8}bar$. Late main Cu-bearing ore mineralization in the vein occurs at about $250^{\circ}C$ which corresponds to sulfur fugacity from about $10^{-13.5}$ to $10^{-11.7}bar$ with oxygen fugacity of about $10^{-38.4}$ to $10^{-35.2}bar$. The late Ag-bearing telluride mineralization in the Hanae hydrothermal system occurs at about $200^{\circ}C$ which corresponds to minium Tellirium fugacity value of about $10^{-18}bar$ with sulfur fugacity of about $10^{-14.0}$ to $10^{-10.9}bar$.

Midterm Results of Bipolar Hemiarthroplasty for Unstable Intertrochanteric Femoral Fractures Using a Type 3C Cementless Stem (불안정성 대퇴골 전자간 골절에 3C형 무시멘트 대퇴 스템을 이용한 고관절 반치환술의 중기 결과)

  • Chung, Woochull;Cho, Hong Man;Kim, Sun do;Park, Jiyeon;Kwon, Kihyun;Lee, Young
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.6
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    • pp.503-510
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    • 2020
  • Purpose: Bipolar hemiarthroplasty is used as an alternative to open reduction and internal fixation for unstable intertrochanteric fractures in elderly patients. Recent advances in medical systems and technologies have resulted in increased survival rates after intertrochanteric fractures of the femur, requiring selection of the appropriate femoral stems considering the mid- to long-term duration of survival. Hemiarthroplasty was performed for unstable intertrochanteric fractures using a double tapered quadrilateral femoral stem (C2 stem), and the clinical and radiological results were evaluated as a five-year follow-up post-surgery. Materials and Methods: From January 2004 to December 2013, 43 patients (43 hips) who underwent hemiarthroplasty with a C2 stem were enrolled in this study. Their mean age was 78.6 years (range, 70-84 years), and the mean follow-up period was 85.4 months (range, 60-96 months). During the follow-up period, clinical parameters, such as the changes in pain, walking ability, and functional status, were examined. Radiologically, changes in the proximal femur, such as osteoporosis and bone resorption of cortical bone, were noted. Complications that occurred during the follow-up period, such as dislocation and prosthetic features, were also reviewed. Results: Initially, the pain was relieved postoperatively, but it increased four years after surgery. The walking ability was reduced by two steps in nine patients after 60 months, and the Harris hip score was reduced significantly postoperatively after two to three years. Radiologically, cortical osteoporosis occurred in 14 patients. Five patients developed cortical bone resorption. Four of them showed nonunion of the trochanteric fracture fragments, and three of them suffered reverse oblique fractures. Conclusion: Careful selection considering the general health condition and remaining lifespan of the patient would be necessary for primary hip hemiarthroplasty using a 3C type cementless femoral stem for unstable intertrochanteric fractures in elderly patients with osteoporosis.

An Epidemiological Study on the Industrial Injuries among Metal Products Manufacturing Workers in Young-Dung-Po, Seoul (일부 금속 및 기계제품 제조업체 근로자들의 산업재해($1980{\sim}1981$)에 관한 조사)

  • Lee, Jung-Hee
    • Journal of Preventive Medicine and Public Health
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    • v.15 no.1
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    • pp.187-196
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    • 1982
  • The followings are the results of the study on industrial accidents occurred at 12 factories manufacturing metal products during the period of 2 years from January 1980 to December 1981 in the area of Yong-Dung-Po in Seoul. The results of the study are as follows: 1. The incidence rate of industrial injuries was 45.7 per 1,000 workers of the sample group and the rate of male (54.0) was three times higher than that of female (17.5). 2. In age groups, the highest rate was observed in the group of under 19 years old with 83.5, while the lowest in the group of 40s. 3. It was found that those who had short term of work experience produced a higher rate of injuries, particularly, the group of workers with less than 1 year of experience showed the highest rate of it as 48.1%. 4. In working time, the highest incidence rate occurred 3 and 7 hours after the beginning of their working showing the rate of 6.0 and 6.1 per 1,000 workers, respectively. 5. The highest incidence rate was observed on Monday as 8.4 per 1,000 workers, and it was 18.3% in aspect of the days of a week. 6. In aspect of the months of a year, the highest incidence was observed on July 1,000 workers and the next was on March as 4.8. These figures account for 11.8% of total occurrence in respective month. as 5. 4 per and 10.5% 7. In causes of injuries, the accident caused by power driven machinery showed the highest rate with 37.5%, the second was due to handling without machinery with 17.2%, and the third was due to falling objects with 14.2%, and striking against objects with 10.2%, and so on. 8. By parts of the body affected, the most injuries 84.3% of them occurred on both upper and lower extremities with the rate of 58.8% for the former and 25.5% for the latter. Fingers were most frequently injured with a rate of 40.3%. Comparing the sites of extremities affected, rate of injuries on the right side was 55.0% and 45.0% on the left side. 9. In the nature of injury, laceration and open wound were the highest with 34. 0%, the next was fracture and dislocation with 31. 9%, and sprain was the third with 8.1%. 10. On the duration of treatment, it lasted less than one month in 68.9% of the injured cases, of which 14.5% of the cases were recovered within 2 weeks, and 54.4% of them were treated more than 2 weeks. And the duration of the treatment tended to be prolonged in larger industries. 11. The ratio of insured accidents to uninsured accidents was 1 to 4.7.

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