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, Kwanhoon Park, Kang Yoon Lee, Ji Young Jang Citations
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, Jung Mo Lee, Taeyang Choi, Kwanhoon Park, Kang Yoon Lee, Ji young Jang Citations
, Ji Young Jang, Sungho Lee 
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The aim of this study is to evaluate treatment outcomes and mortality risks associated with hemodynamic instability caused by severe pelvic fracture in a regional trauma center.
The medical charts of 44 patients with hemodynamic instability due to pelvic fractures who were admitted to a regional trauma center from January 2014 to May 2017 were analyzed retrospectively.
The mean age was 61.8 years, and the mean injury severity score was 39.1. Twenty-six patients (59.1%) were transferred from other hospitals, and the median time from injury to emergency room arrival was 115.5 minutes. Preperitoneal pelvic packing, pelvic angiography, and external pelvic fixation were performed in 38 patients (86.4%) for hemostasis. The mortality rate was 52.3%, and 15 patients (34.1%) died from hemorrhage. Logistic regression analysis showed that initial low systolic blood pressure and packed red blood cell (PRBC) requirement were independent risk factors associated with mortality. PRBC requirement for four hours and application of emergent hemostatic procedures were independent factors associated with hemorrhage-induced mortality.
Emergency procedures for hemostasis should be performed immediately for patients with hemodynamic instability due to pelvic fracture, and they should be transferred to a regional trauma center as soon as possible.
Abdominal tuberculosis is a rare disease, about 5% of extra-pulmonary tuberculosis. However, the diagnosis of abdominal tuberculosis is difficult, because of its atypical symptoms and signs, and ambiguous results upon physical examination. When abdominal tuberculosis is combined with abdominal injury, the diagnosis will be especially complex. We present our experience of abdominal tuberculosis associated with abdominal trauma.
This retrospective study evaluated the clinical utility of the delta neutrophil index (DNI) as a predictor of mortality in critically ill surgical patients with
The medical records of 104 surgical patients with AB pneumonia treated from March 2011 to October 2014 were reviewed and analyzed.
The mean patient age was 60.8±18.8 years, and the mean Acute Physiology and Chronic Health Evaluation II score was 15.8±5.3. At the time of culture, 16 patients (15.4%) had renal failure, and the median DNI was 2.7% (0∼39.4%). Twenty-four patients (23.1%) died from infection during intensive care unit admission. Bivariate analysis indicated that several factors were associated with mortality, namely age, occurrence of shock, renal failure, low platelet count and elevated DNI at the time of culture. Logistic regression analysis revealed that elevated DNI (odds ratio [OR], 1.136; 95% confidence interval [CI], 1.001∼1.288), acute renal failure (OR, 3.811; 95% CI, 1.025∼14.176) and decreased platelet count (OR, 0.994; 95% CI, 0.989∼1.000) at the time of culture are associated with mortality. When a receiver-operating characteristics curve was constructed to determine the optimal cut-off value to predict mortality within seven days of the bacterial culture, the area under the curve was 0.839 (95% CI, 0.694∼0.985) and the cut-off DNI value was 6.85%.
DNI may be an effective predictor of mortality in critically ill surgical patients with AB pneumonia.
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Hemodynamic monitoring continuously checks hemodynamic variables for problems so that the clinician can treat them when a patient’s vital signs are unstable. There are many different monitoring systems, and many new technologies were developed over the past three decades. It is challenging to understand the many monitoring system in the intensive care units, for example. However, all such monitoring systems are based on the general principle of monitoring oxygen transport to a peripheral organ. In this review, from conventional to recent principles, general concepts and paradigm shifts of hemodynamic monitoring will be discussed.
The mortality of patients with hemodynamic instability due to severe pelvic fracture is high despite multidisciplinary management. Current management algorithms for these patients emphasize pelvic angioembolization (AE) for hemorrhage control. However, a surgical procedure is often needed because AE is time-consuming and approximately only 15% of patients have arterial bleeding. Most hemorrhages from severe pelvic fracture originate from venous or bone injury. Current research demonstrates the effectiveness of preperitoneal pelvic packing (PPP) in hemorrhage control. However, there are no reports of its use in Korea. Accordingly, we present our early experiences of PPP for control of hemorrhage due to severe pelvic fracture in a trauma center in Korea.
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Research comparing the effectiveness of different doses of antibiotics prior to surgery for preventing infection is sparse. This study examines whether a single dose of preoperative antibiotics suffices to treat uncomplicated appendicitis via laparoscopic appendectomy.
This study retrospectively reviewed the medical records of 149 patients who underwent laparoscopic appendectomy from July 2013 to December 2014 in a single institution. The participants were divided into two groups; group A (n=99) was given a single dose of prophylactic antibiotics before surgery, and group B (n=50) was given both preoperative and postoperative antibiotics. Clinical factors and surgical outcomes were compared between two groups.
The mean length of hospital stay for group A (2.5 days) was shorter than for group B (3.2 days) (p<0.001). Average operation time was 58.7 minutes for group A, longer than for group B (52.2 minutes, p=0.027). There was no difference in pathologic results and postoperative complications, such as surgical site infection (SSI) between the two groups. In groups A and B, 4.0% of patients had superficial SSIs. One patient (2.0%) in group B had deep/organ SSI.
A single dose of prophylactic antibiotics administration to patients undergoing laparoscopic appendectomy is acceptable as a treatment in uncomplicated appendicitis.
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