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- Volume 4(1); June 1991
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- Clinical significances of band form on CBC immediately after multiple trauma
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Tae Hyeong Kwon, Kyoung Soo Lim
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J Korean Soc Traumatol. 1991;4(1):3-11.
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Abstract
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- On CBC examined immediately after multiple trauma, surgeons and emergency physicians couldn``t get much informations about injury severity and degree of injury. In other words, the leukocytosis didn``t reveal injury severity and hemoglobin/hematocrit level done immediately after trauma was normal range althought internal bleeding was continued. But band form count in leukocytes reveals close relation with injury severity and mortality. One hundred twenty two patients were studied prospectively to assess the injury severtiy and mortality according to band form(%) on CBC. Among them, 25 patients was re-examinated to calculate the immune cells(lymphocyte, T cell, Helper T cell(Th) and cytotoxicsuppressor T cell(Tc/s) and Th: Tc/s ratio). The patients(n=17) with band form above 3% in differential count of CBC revealed 27.0 ± 10.25 in Injury Severity Score(ISS), and group with below 3% was 14.8±8.76(P<0.00l). The mortality of patients with band form above 3% was three times higher than patients with below 3%. The Th : Tc/s ratio was 0.98: 1 in patients with band23%(n=6) and 1.27 in band<3%(n=19). In summary, the patients with band forms above 3% on CBC immediately after trauma were severly injured and immune function was much decreased. So emergency physicians must re-evaluate the injured patients if band form was above 3% in differential count of CBC.
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Summary
- Clinical Importance and Treatment of Traumatic Retroperitoneal Hematoma
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Tae Wan Ahn, Joon Pil Cho, Hoon Sang Chi, Byung Ro Kim
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J Korean Soc Traumatol. 1991;4(1):10-29.
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- The management of retroperitoneal hematomas remains to be confusing to many surgeons because it often does not correlated well with the underlying mechanism of injuries and the treatment may differ considerably. So we reviewed 70 patients who had been admitted due to traumatic retroperitoneal hematomas at Young Dong Severance Hospital, Yonsei University College of Medicine from January 1986 to December 1990. 70 patients had retroperitoneal hematoma among 260 who had sustained abdominal trauma (blunt injury: 180, penetrating injury: 80). The most common cause was pedestrianauto accident who accounted 33 patients. According to Selivanov, the retroperitoneal hematoma is classified as Zone I (central), II (flank) and III (pelvic). In our series, the Zone I retroperitoneal hematoma consisted 18.6%, Zone II 31.4% and Zone III 58.6% ; the pelvic bone fracture was the most frequently implicated with retroperitoneal hematoma. Exploratory laparomy was performed in 27 patients and 43 patients were treated conservatively. 24 patients had hypovolemic shock at the emergency room and 5 of them expired (mortality rate: 20.8%). 12 patients required 6-15 units of blood and 3 of them died (mortality rate: 25%). 5 patients rquired more than 16 units of blood and 2 died (mortality rate: 40%). 14 patients recieved ventilatory care for more than 24 hours and 5 died. The overall mortality rate was 8.6% (6 out of 70).
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Summary
- Penetrating Abdominal Injury by Army Weapon
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Il Cheol Lee, Byong Wook Lee, Hyucksang Lee
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J Korean Soc Traumatol. 1991;4(1):21-53.
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- From January 1987 through April 1991, 43 casualties underwent surgical treatment for the penetrating abdominal injuries by army weapons at Capital Armed Forces General Hospital. Clinical data on these patients were analyzed and the results were as follows: 1) Mean age of the patients was 22.0 years and all but one casualty were male. 2) The weapons involved were M-16 rifles, K-2 rifles, hand grenades, pistols, kremor, hand mine, and M-60 machine gun. 3) The mean interval of time between the injury and the initial management at our ER was 110 minutes. 4) The initial mean systolic blood pressure of overall patients was 97 mmHg. In survivors and in those who eventually succumbed, it was 105 and 80, respectively. 5) The initial mean hemoglobin levels for these three groups were 10.89 gm/dl, 11.42 gm/dl, and 9.8 gm/dl, respectively. 6) The mean total blood transfused up until the termination of operative procedure were 7.5, 5.8, and 15.7 units in these groups, respectively. 7) The mean number of injured organs per patient were 2.8, 2.6, and 4.1, respectively. The commonly injured organs were small bowel, colon, liver, and stomach in order of frequency. 8) Postoperative abdominal complication rate was 27.5%, the most common being wound infection.9) There were seven deaths with overall mortality rate of 16.3% They were attributed to shock, ARDS, and Spesis. 10) The factors affecting the mortality were initial systolic BP below 85 mmHg, initial Hb value of 9.0 gm/dl or lower,whole blood transfusion in escess of 7 units, the injured organs numbering more than 5, major vascular injury, and conplicating intraabdominal descess.
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Summary
- Clinical Analysis of Pelvic Fracture
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Han Koo Lee, Sang Hoon Lee, Francis Youngin Lee, Tae Joon Cho, Sung Soo Chung
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J Korean Soc Traumatol. 1991;4(1):34-72.
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Abstract
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- Fractures of the pelvis constitute one out of every 1000 surgical admissions and 3% of all skeletal fractures. Traffic accidents and fall from heights are the most important sources of these injuries. Thus the magnitude of the fracturing force is so great that it usually causes serious injuries to the other areas of the body in addition to local trauma to the viscera and the neurovascular structures contained within the pelvis. The fractured pelvis continues to contribute significantly to trauma``s overall death rate because of delays in the diagnosis and the control of hemorrhage. The purpose of this study was to review the patients with pelvic bone fracture and to assess the results. Twenty-eight patients with the pelvic bone fracture were treated during the period of Dec. 1985 to Dec. 1989 at the Department of Orthopaedic Surgery of the Seoul National University Hospital. There were 7 females and 21 males, whose age ranged from 17 to 77 years averaging 40.5 years. The follow-up period ranged from 11 to 48 months averaging 25months. Traffic accident was the cause of the fracture in 16 patients(57.1 %), while fall from heights was in 10 patients(35.7%) and the other causes were in 2 patients(7.2%). Fractures of the other sites were combined in 21 patients and visceral injuries were found in 8 patients. Of the 28 patients, 16 patients have acetabular fracture and 12 patients have pelvic ring. fracture. Thirteen patients of the acetablular fractures were treated by open reduction and internal fixation and the rests of the acetabular fractures and all of the pelvic ring fractures were treated conservatively. Urethral injury, hematoma, sciatic nerve palsy, degenerative arthritis, and non-union were the complications. The results of the 26 patients of the 28 pelvic fractures were satisfactory and two cases with severe degenerative arthritis showed unsatisfactory results.
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Summary
- Clinical Review of 312 cases of Postburn Death
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Ok Sun Park, Young Cheol Lee, Hong Rae Cho, Sung Kim, Won Jin Choi
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J Korean Soc Traumatol. 1991;4(1):40-95.
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- There were 312 deaths among 1702 burn patients admitted to the Department of Surgery and Burns Unit at Han Gang Scacred Heart Hospital, College of Medicine, Hallym University during four and half years from July 1986 to December 1990. This represents an overall mortality of 18.3%; 73.7per cent of the patients who died had sustained more than 50 per cent of total burn surface area(TBSA). A large number of deaths occured in two age groups, 21-30years(81 cases, 25.9%) and 31-40years(79cases, 25.3%). The male to female ratio of burn induced deaths was 2.4: 1. The mean burn surface area was 71per cent. Flame burns due to domestic accidents were the etiological factors in majority of patients; 254cases(81.5%) of those who died sustained flame burns. In 186cases(59.6%) the accident occured at home, mainly in the kitchen, while 94cases(30.1%) occured at work. The patients belonged to various occupational categories; manual and semi-skilled workers(1l4cases, 36.5%), pre-school age groups(53cases, 17.0%), housewives(33cases, 10.6%). 153cases(49.0%) died of wound sepsis, with its related MOF(multipe organ failures), remains the most important cause of death in our burn patients. The mean survival period was 11days postburn, the thirty-three cases(1O.6%) died within 24hours postburn, the longest period being 270days for a patient with 35% of TBSA
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Summary
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