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Volume 17(1); June 2004
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Original Articles
Effect of Administ ration of Glutamine and N-Acety l cysteine on Hepatic Antioxidant Mechanisms in Sepsis
Song Bin Chon, M.D., Jee Soo Kim, M.D.*, Chang Hyun Lee, M.D.**, Sung Eun Jung, M.D.***, Yeo Kyu Youn, M.D.***, Gil Joon Suh, M.D.
J Korean Soc Traumatol. 2004;17(1):1-9.
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Background
Glutathione (GSH) has been known to be an important intracellular antioxidant. The aim of this study was to investigate the effects of the glutamine and N-acetylcysteine (NAC) on lipid peroxidation and antioxidant effect in sepsis model. Methods: All female Sprague-Dawley rats were given an intraperitoneal diethylmaleate (DEM) injection before treatment, and divided into four groups: control group (DEM only), lipopolysaccharide (LPS) treated group (DLPS), LPS with glutamine treated group (DLPG) and LPS with both glutamine and NAC treated group (DLPGC). Animals were killed at 6 and 24 hours after treatment. The histology and the counts of the infiltrative neutrophils, and the levels of malondialdehyde (MDA) and GSH in the liver were measured. Results: While the liver histology in the both DLPG and DLPGC groups showed mild neutrophil infiltration, vacuolization of hepatocytes, and the sinusoidal dilation compared to those of the DLPS group, there was no significant change of the neutrophil counts between the treatment groups. Both the DLPG and DLPGC groups showed decreases in liver MDA level compared to the DLPS group. Although both the DLPG and DLPGC groups demonstrated significant increases in the liver GSH level compared to the DLPS group, there was no significant change between the DLPG and DLPGC groups. Conclusion: This study showed that the administration of the glutamine and NAC in sepsis model revealed an inhibition of the lipid peroxidation and an antioxidant effect through the increase of GSH in the liver.
Summary
Comparison of Systemic Inflammatory Response Syndrome Criteria and other Indicators for Predicting Outcome in Traumatic Intensive Care Unit Patient
Jun Ho Lee, M.D., Sun Jung Lee, M.D., Jun Ho Lee, M.D.*, Kwang Won Cho, M.D.*, Seong Youn Hwang, M.D.*, Chang Hae Pyo, M.D.**
J Korean Soc Traumatol. 2004;17(1):10-19.
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Background
Since the systemic inflammatory response syndrome (SIRS) was first introduced in 1992, it has been well-known as an significant indicator to predict the level of severity and outcomes in medical, surgical and trauma patients for the last ten years. There are several other indicators such as triage Revised Trauma Score (t-RTS), Triage Score (TS), Trauma and Injury Severity Score (TRISS), Acute Physiology and Chronic Health Evaluation (APACHE), and Simplified Acute Physiology Score (SAPS) to predict trauma patients’severity and outcomes, and the authors focused on comparing the SIRS with those five other indicators to predict severity and outcome of traumatic intensive care unit (ICU) patients. Material and Method: The retrospective medical records of four hundred forty one consecutive ICU trauma patients from the emergency center, Masan Samsung Hospital from March 2002 and February 2003 have been carefully examined, and among them, three hundred fifty six were included as the target of this research. The t-RTS, TS and TRISS were calculated based on the record from the emergency center and operating rooms while SIRS, APACHE Ⅱ and SAPS Ⅱ were measured by the data for the first twenty four hours after their ICU hospitalization. The predictability of SIRS and other indicators was evaluated by using two by two decision matrices and receiver operating characteristic (ROC) curve analysis. Result: Using injury severity score 15 as the gold standard, the accuracy of SIRS was higher than t-RTS, yet it was not higher than the one of TS (p<0.01). And the areas under the ROC curves of the SIRS, TS and t-RTS were 0.645±0.073, 0.803±0.054 and 0.766±0.054, respectively (p<0.01 vs. SIRS). Using survival as the gold standard, the accuracy of SIRS was remarkably lower than the ones of TRISS, APACHE Ⅱ and SAPS Ⅱ(p<0.01 vs. SIRS). And the areas under the ROC curves of the SIRS, TRISS, APACHE Ⅱ and SAPS Ⅱ were 0.665±0 . 0 5 2 , 0.925±0.023, 0.946±0.025, and 0.965±0.017, respectively(p<0.001 vs. SIRS). Conclusion: The authors concluded that even though SIRS was closely related to death rate and injury severity score, yet its predictability was lower than the ones of other indicators mentioned above.
Summary
Significance of Shock Index in Hemmorrhagic Shock and Septic Shock Patients
Be Ahn Lee, M.D., Sang Hun Jung, M.D., Gap Su Han, M.D., Sung Woo Lee, M.D., Yun Sik Hong, M.D.
J Korean Soc Traumatol. 2004;17(1):20-26.
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Background
Shock Index (SI) is a ratio calculated to weigh Heart rate and Systolic Blood Pressure (SBP) differently. As we know increased the SI over 0.9 is a early predictor of circulatory failure induced by hypovolemia. This study was designed to evaluate the SI as a value of prognostic factor in Hemmorrhagic Shock and Septic Shock patients. Methods: From March 2001 to February 2002, patients presenting to the Emergency department with post traumatic hemorrhagic shock and septic shock patients. Exclusion criteria were age less than 15 years, cardiopulmonary arrest and death on arrival. We compared with admission days, ICU periods, survival rate, Revised trauma score, Base excess, and total amounts of transfusion for evaluation of reliability. Two groups were identified by the SI: group1 had an SI of more than 0.9, and group2 had an SI of less than 0.9. Results: There were 29 hemmorrhagic shock patients, and 30 septic shock patiens. In hemmorrhagic shock, group 1 had significantly higher value of compared items (p<0.05). In septic shock, the value were not significantly different between group1 and group 2 (p> 0.05). Conclusion: The SI may be useful to evaluate acute hemodynamic status induced by hypovolemia. But the SI cannot be useful to evaluate hemodynamic status induced by multiorgan dysfunction. The SI cannot be a predictor of prognosis in septic shock.
Summary
Qualitative Analysis of Anti-tetanus Antibody Titers in Korean
You Dong Sohn, M.D., Kyoung Soo Lim, M.D., Wook Jin Choi, M.D., Ji Yun Ahn, M.D., Won Kim, M.D., Youn-Back Choi, M.D.*, Eun Seok Hong, M.D.**
J Korean Soc Traumatol. 2004;17(1):27-36.
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Background
In Korea, vaccination against tetanus began in the mid-1950s. At present, there is a routine immunization schedule with diphtheria, pertussis, and tetanus (DPT) vaccines at 2,4,6 month after birth and booster at 15-18 month and 4-6 years. However, further prophylactic programs according to guidelines of Center for Disease Control do not exist due to the absence of tetanus toxoid. And we have usually used only passive immunization, tetanus immunoglobulin, as a prophylactic regimen for injured patients. In this study, we aimed to determine the tetanus antibody titers levels of Koreans and point out problems of prophylactic programs after a routine immunization schedule. Methods: This study was conducted with 112 healthy adults from August 29, 2003 to September 19, 2003. No volunteers had unstable vital signs, or had taken any medication for chronic illnesses. A questionnaire was used for the volunteers to assess their knowledge about tetanus vaccination schedule, and the whole blood was withdrawn from each volunteer to determine qualitative anti-tetanus antibody titers using TQS (Tetanus Quick Stick). TQS had been introduced as a rapid, easy method to determine the immune status. Results: Of the 112 studied subjects, only 13 (11.6%) were found to have protective levels of anti-tetanus antibody titers. There was no association between quantitative antibody titers and age, sex, educational status, economy, place of birth or residence, military service, and vaccination. Conclusion: Although tetanus is a preventive disease by the antibodies developed as a result of vaccination and its occurrence is not very common, it is associated with a rather high mortality rate. Recently, there has beena tetanus immunization shortage in Korea caused by an absence of tetanus toxoid. The effect of a tetanus shortage makes the tetanus antibody values go under the protective level for most adults. We recommend that tetanus prophylaxis in Korea should be performed following the guidelines of Center for Disease Control and Prevention.
Summary
The Status of Incidence and The Prognostic Factorsin Geriatric Trauma Patients
Young-Mo Yang, M.D., Eun-Sook Kim, N.R.*
J Korean Soc Traumatol. 2004;17(1):37-48.
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Purpose
This study was to survey on the incidence status and the prognostic factors in geriatric trauma patients Method: The patients were older than 65 years and the number of patients was 231 who visited one of the emergency medical center in Daejon from January 1, 2002 to December 31, 2002. Results & Conclusions: (1) Although the onset time of geriatric trauma was most common at 12-18 o’clock and the onset season was common in autumn, the statistical significance was none. The statistical significance of the injured parts and the type of injury by season were none. (2) Slip down and traffic accidents, in order, were common as the types of trauma. As the injured parts by slip down and traffic accidents, the extremities and pelvic area were common. As the location of trauma, the room and the road were common. (3) Below 15 points of ISS were most common and above 16 points were common at the head and neck injuries. (4) Age, marital state, history of illness, injured parts, and ISS had no influence on the admission period. The complication had influence on ICU admission period. The traffic accidents was associated with the longer total admission period than any other types of trauma. (5) The group above 75 years of the age, the group having no spouse, the injuries at the extremities and pelvic area, above 16 points of ISS showed the significant functional changes after discharge.
Summary
Clinical Rev i ew of the Smoke Inhalation Injured Victims of a Large Fire
Dong Hoan Seol, M.D.
J Korean Soc Traumatol. 2004;17(1):49-55.
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Background
Many of fire victims of large fires die from smoke inhalation injury. For this reason, it is important to diagnose and manage smoke inhalation injuries. The purposes of this study were to find effectiveness in use of chest x-ray and bronchoscopic examination in diagnosis and management of smoke inhalation injury. Method: We analyzed the case histories of victims of a large fire who visited the emergency department of Kyungpook National University Hospital from the day admission, February, 18, 2003 to the time of each patient’s discharge. Results: The results of this study showed that severity of chest x-rays at the day 2 of insult correlated with PaO2/FiO2 ratio, Pulmonary function tests. bronchoscopic exam and wash out, oxygen therapy, medications, etc. were effective in improving patient’s clinical course. Conclusions: Follow up chest x-ray can be helpful in classifying severity, diagnosing and managing smoke inhalation injured patients. In addition to other supportive care, bronchoscopic tracheal wash out technique could be useful in managing these patients.
Summary
Risk Factors Related with Injury and Pre-hospital Emergency Service System in School
Kyoung Jun Song, M.D., Sung Goo Jeong, M.D., Young Ho Kwak, M.D., Gil Joon Suh, M.D., and Woon Yong Kwon, M.D.*, Sang Do Shin, M.D.**,
J Korean Soc Traumatol. 2004;17(1):56-66.
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Purpose
This study was designed to evaluate the risk factors of injury and pre-hospital emergency service system in school. Methods: A designed questionnaire was made up by nurse-teachers. We described the frequency and the distribution by types of school, gaining method of information about emergency care, education programs and concerns about injury prevention, transportation methods, and number of injured victim. After all school were divided with two groups such as high and low injury group based on median points of injury count, the adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) of each risk factor were measured using the multivariate logistic regression analysis. Results: 246 female nurse-teachers were responded. Of them, 143 worked at primary school, 50 at middle school, 29 at high school, and 18 at special school, respectively. Injury was the second common cause visiting to nursing room. 43.67% of victims were directly transported by nurse-teacher. Degree of attention about injury prevention was relatively high (63.0%) but education program was not sufficient (83.0%). There were no oxygen devices, ventilatory devices, airway maintenance devices, electrocardiography equipments, and critical drugs except immobilization devices, stretchers, oral antibiotics, and fluids in most schools. Mean number of victim visiting to nursing room due to injury was 2.6 per a day per 1,000 stu-dents. Adjusting for related factors, ‘disordered shopping and parking area to near school’ (adjusted OR 1.840; 95% CI 1.077~3.143), ‘risky window without safety equipment’(adjusted OR 1.786; 95% CI 1.019~3.131), and ‘when number of involved indoor condition was increased by one’(adjusted OR 1.255 95% CI 1.004~1.568) were significant risk factors on high injury incidence. Conclusion: Injury was one of the most common health problems in school but there was no equipped for emergency care. ‘Disordered street near to school’and ‘risky indoor conditions’ were significant risk factors on school injury.
Summary
A Clinical Analysis of Traumatic Diaphragmatic Injury
Yohan Kim, M.D.
J Korean Soc Traumatol. 2004;17(1):67-73.
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Background
Traumatic diaphragmatic injury is an occult and often dangerous injury which is encountered with increasing frequency as a result of the growing number of traumas. Although rarely lethal, it may threaten life by upsetting cardiorespiratory dynamics or it can cause chronic gastrointestinal symptoms for many months before presenting with obstruction and strangulation. To analyze the clinical and radiological features and the therapeutic implications, a retrospective analysis was performed. Material and Methods: We reviewed the charts and radiographs of 29 patients with traumatic injury of the diaphragm treated in our hospital from 1994 to 2003. Results: This injury affects predominantly males (male:female=21:8) in the third to forth decade of life, and often caused by blunt trauma (86.2%). Traumatic diaphragmatic injurry was left-sided in 25 cases (86%), right-sided in 4 (14%). Preoperative diagnosis was made in 17 cases (58%) and 11 cases were diagnosed intraoperativly. In one case, a left diaphragmatic injury was missed on initial evaluation but became apparent after the other operation. Most common postoperative complication was respiratory failures and all patients were treated by ventilatory supports. There were 4 (13.8%) early hospital deaths because of combined injuries. Conclusions: Uniform diagnosis and treatment depend on a high index of suspicion, careful scrutiny of the chest roentgenogram in patients with thoracoabdominal or multiple trauma, and meticulous inspection of the diaphragm when operating for concurrent injuries.
Summary
Disclosure of Unnoticed Rib Fractures with the use of Ultrasonography in Minor Blunt Chest Trauma
Yohan Kim, M.D., Eun Gu Hwang, M.D., Song Am Lee, M.D., Jin-Woong Lee, M.D.*, Chang Hee Lee,M.D.**, Young Chil Choi, M.D.**
J Korean Soc Traumatol. 2004;17(1):74-80.
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Background
Rib fractures are the most common injuries resulting from blunt chest trauma. The sensitivity of conventional radiogrphy in showing the rib fracture is limited especially in whom involving the cartilage part of the rib. We investigated the rib fractures, those overlooked on conventional radiography, with the use of ultrasonography in minor blunt chest trauma. Materials and Methods: From september 2002 to March 2004, 40 patients (21 women and 29 men, mean age 43.3±15.1,range 16~85 years), with minor blunt chest trauma showing no evidence of rib fractures on conventional radiography, were admitted for examination with ultrasonography. Logistic regression analysis was done to outlined the clinical predictors of these incidious rib fractures. Results: A total of 15 (35%) patients showed rib lesions, whereas 25 (65%) patients had no evidence of rib lesions. Fractures of rib associated with a periosteal hematoma was the most common finding in ten (66.7%) patients followed by the rib fracture of the rib alone in four (26.7%) patients and subperiosteal hematoma alone in one (6.6%) patient. A total of eight (53.3%) patients had bony rib fractures, whereas seven (46.7%) patients had chondral rib fractures. Age (p=0.280), gender (p=0.431), type of etiology (p=0.823), duration of pain (p=0.470) and site of trauma (p=0.923) did not appear as significant predictors for these rib fractures. However, involved part of the rib showed a significant correlation with either age (p=0.043) or duration of pain (p=0.036). Bony rib fractures significantly occurred in elderly patients, and the duration of pain in patients with bony rib fractures was significantly longer than that of the patients with chondral rib fractures. Conclusions: Ultrasonography is a useful imaging method in showing the rib fractures those overlooked on conventional radiography in minor blunt chest trauma, and no significant clinical feature exists as a predictor for these insidious fractures. However, bony rib fractures significantly occur in elderly patients and result in a longer duration or pain.
Summary
Clinical manifestation and Treatment: Multicenter study in Korea
Jong Bouk Lee, Jae Hyun Lee, Bum Sang Ryu, Jong Bo Choi*, Kyung Sup Lee**, Hong Sup Kim***
J Korean Soc Traumatol. 2004;17(1):81-87.
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Background
s: Penile fracture is the traumatic injury of the tunica albuginea of the corpus carvernosum in erectile state. This study was designed to evaluate clinical manifestations, diagnostic and therapeutic modalities. Methods: Between December 1992 and July 2003, 72 patients were evaluated after penile injury. History taking and physical examination were performed in each patient and if needed, radiologic examination and operation was undergone. Results: The mean age of patients was 42 years old (18-72 years old), and causes of penile fracture were sexual intercourse (44 cases: 61.1%), masturbation (8 cases: 20.8%), and fingerpressure (4 cases: 5.6%) in order. As a preoperative radiologic examination, penile sonography was performed in 30 cases and carvernosogram in 20 cases. In each group, 4 and 3 cases who showed no sign of penile fracture underwent an operation, and it revealed carvernosal rupture in 1 case in both groups. Among 57 patients (79.1%) who had an early operation, 52 patients were found to have rupture of corpus carvernosum. The most common site of penile fracture was proximal shaft (28 cases: 53.9%) and then midshaft (15 cases: 28.9%) and distal shaft (5 cases:9.6%). Injury involved unilateral and bilateral corporeal rupture in 49 cases (Rt.:35, Lt.:14) and 3 cases. The overall complication rate in patients who had an early operation was 8.9% (4 of 45 cases) in compare to 66.7% (8 of 12 cases) in patients who did not. Conclusions: Our experience demonstrates that the most common cause and site of penile injury are sexual intercourse and right proximal shaft respectively, and an early operation would be an effective treatment to prevent complications. When penile fracture is not clinically definite, radiologic examination, such as carvernosogram or penile sonography, can be helpful in making diagnostic and therapeutic plan.
Summary
Efficacy of Immediate Indwelling of the Urethral Catheter in Partial Urethral Rupture
Hong Yong Choi, M.D., Jong Jin Lee, M.D.
J Korean Soc Traumatol. 2004;17(1):88-91.
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Background
We reviewed our experience in managing partial urethral rupture patients with immediate indwelling of the urethral catheter. Patients and Methods: Between January 1996 and December 2002 a total of 32 consecutive male patients with partial urethral rupture were reviewed retrospectively, including a clinical and radiographic of the retrograde urethrography. The average patient age was 50.6 years (14-87 years). The mechanisms of injury were represented by the blunt perineal trauma with straddle injury in 23 patients, accidental Foley catheter removal with ballooning in 5 patients, penile fracture in 3 patients and pelvic bone fracture in one patient. Results: All patients were diagnosed partial urethral rupture with retrograde urethrography and treated with immediate indwelling of the silicon urethral catheter. That were successfully performed at 1st or 2nd trial in 30 (94%) among 32 patients. There were no significant complication and average peak flow rate was 22.0ml/sec (16-30 ml/sec). Conclusion: Immediate careful indwelling of the urethral catheter was safe and effective treatment in partial urethral rupture with intact alignment.
Summary

J Trauma Inj : Journal of Trauma and Injury