PURPOSE: This study was designed to provide a basis for building a master plan for a regional trauma system by analyzing the distribution of trauma deaths in the most populous province in Korea.MATERIALS AND METHODS: We investigated the time distribution to death for trauma patients who died between January and December 2017. The time distribution to death was categorized into four groups (within a day, within a week, within a month, and over a month). Additionally, the distribution of deaths within 24 hours was further analyzed. We also reviewed the distribution of deaths according to the cause of death and mechanism of injury.RESULTS: Of the 1546 trauma deaths, 328 cases were included in the final study population. Patients who died within a day were the most prevalent (40.9%). Of those who died within a day, the cases within an hour accounted for 40.3% of the highest proportion. The majority of trauma deaths within 4 hours were caused by traffic-related accidents (60.4%). The deaths caused by bleeding and central nervous system injuries accounted for most (70.1%) of the early deaths, whereas multi-organ dysfunction syndrome/sepsis had the highest ratio (69.7%) in the late deaths. Statistically significant differences were found in time distribution according to the mechanism of injury and cause of death (p<0.001).CONCLUSION: The distribution of overall timing of death was shown to follow a bimodal pattern rather than a trimodal model in Korea. Based on our findings, a suitable and modified trauma system must be developed.
Cause of Death ; Central Nervous System ; Hemorrhage ; Humans ; Korea ; Wounds and Injuries

Microtubules have been among the most successful targets in anticancer therapy and a large number of microtubule-targeting agents (MTAs) are in various stages of clinical development for the treatment of several malignancies. Given that injury and diseases in the central nervous system (CNS) are accompanied by acute or chronic disruption of the structural integrity of neurons and that microtubules provide structural support for the nervous system at cellular and intracellular levels, microtubules are emerging as potential therapeutic targets for treating CNS disorders. It has been postulated that exogenous application of MTAs might prevent the breakdown or degradation of microtubules after injury or during neurodegeneration, which will thereby aid in preserving the structural integrity and function of the nervous system. Here we review recent evidence that supports this notion and also discuss potential risks of targeting microtubules as a therapy for treating nerve injury and neurodegenerative diseases.
Central Nervous System* ; Microtubules ; Nerve Degeneration ; Nervous System ; Neurodegenerative Diseases ; Neurons ; Wounds and Injuries

Electrical shock can result in neurological complications, involving both peripheral and central nervous systems, which may present immediately or later on. However, delayed neurological complications caused by low-voltage electric shock are rarely reported. Here, a case of a man suffering from weakness and aphasia due to the delayed-onset of the peripheral nerve injury and ischemic stroke following an electrical shock is presented. Possible mechanisms underlying the neurological complications include thermal injury to perineural tissue, overactivity of the sympathetic nervous system, vascular injury, and histological or electrophysiological changes. Moreover, vasospasms caused by low-voltage alternating current may predispose individuals to ischemic stroke. Therefore, clinicians should consider the possibility of neurological complications, even if the onset of the symptoms is delayed, and should perform diagnostic tests, such as electrophysiology or imaging, when patients present with weakness following an electric injury.
Aphasia ; Central Nervous System ; Diagnostic Tests, Routine ; Electric Injuries* ; Electrophysiology ; Humans ; Peripheral Nerve Injuries ; Shock ; Stroke ; Sympathetic Nervous System ; Vascular System Injuries

The sympathetic skin response(SSR) is a simple test to assess sympathetic nerve function through sudomotor activity after electric stimulation. However the electrophysiologic characteristics of sympathetic skin response have not been fully documented regardless of the impending necessities. To understand the characteristics of central conduction of SSR by taking SSRs in various central nervous system diseases, 336 SSRs were measured in 14 stroke patients, 6 spinal cord injury patients and 2 traumatic brain injury patients and analysed by classifying into no response(NR), slight and normal groups. In stroke patients, normal SSRs were obtained more in hemiplegic side than non-hemiplegic side after both limb stimulations. And normal SSR were obtained more in left hemiplegic patients than right hemiplegic patients even though number of subject was limited. The patterns of SSR in traumatic brain injured and spinal cord injured patients were not so closely correlated with severity of clinical symptoms and abnormal somatosensory evoked potentials. The sympathetic skin response seems to be exclusively under the control of central nervous system of which the subcortex would be regarded as the sudomotor reflex center.
Brain ; Brain Injuries ; Central Nervous System Diseases ; Central Nervous System* ; Electric Stimulation ; Evoked Potentials, Somatosensory ; Extremities ; Hemiplegia ; Humans ; Reflex ; Skin* ; Spinal Cord ; Spinal Cord Injuries ; Stroke

Historically, peripheral neuropathic pain has occasionally been difficult to treat. Both a systematic review of the evidence as well as clinical experience have demonstrated that treatment options including polypharmacy provide effective pain relief in only half of the patients with neuropathic pain. After peripheral nerve injury, the incidence of degenerative alterations in the spinal cord and central pathologic sensitization are possible. Due to this observation, It may be difficult to treat this group of patients with peripheral neuropathic pain by therapeutic intervention of the peripheral nerve. Pulsed radiofrequency (PRF) has several benefits for treatment of this condition including, accuracy and safety, and the elimination of thermal lesions due to the reduction in the target tissue temperature (below 42 degrees). We treated three cases of supraorbital neuropathic pain using PRF, and discovered that two of the patients had significant pain relief at the six month time point.
Central Nervous System Sensitization ; Humans ; Incidence ; Neuralgia ; Peripheral Nerve Injuries ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Polypharmacy ; Spinal Cord

Composite graft and local flaps are good modality for the correction of deformatic scars in facial area but there are several limitations in size, shape and graft bed condition. Hyperbaric oxygen therapy is a good adjunctive therapy for the successful take of the composite graft and local flaps by providing high arterial oxygen pressure and hyperoxic state promoting angiogenesis and collagen synthesis. However, it has some substantial risks of systemic oxygen toxicity to central nervous system, lung and eyes, and needs hyperbaric chamber system and high cost. We designed a modified technique for administrating hyperbaric oxygen topically with the use of simple materials and wall oxygen for the composite graft and local flap wound. 8 patients who had undergone composite graft and local flap on facial scar area were treated with topical hyperbaric therapy for average 6 days. Grafts were relatively large in size and all of the graft bed was scar tissue due to previous operation, trauma and burn injury. All cases showed successful result and there was no complication reported. The potential advantage of this method includes fairly low expense, no need for specialized equipment, simplicity of the application and lack of systemic complication. We conclude that topical hyperbaric oxygen therapy was a simple, cost-effective and safe method for the adjunctive treatment to the composite graft and local flaps.
Burns ; Central Nervous System ; Cicatrix ; Collagen ; Humans ; Hyperbaric Oxygenation* ; Lung ; Oxygen ; Transplants* ; Wounds and Injuries

BACKGROUND: A low dose of ketamine can be an effective preemptive analgesic by preventing central sensitization when administered before surgical trauma. In this study, we assessed the preemptive analgesic effect of low-dose ketamine administered intravenously to patients undergoing arthroscopic rotator cuff repair with intra articular ropivacaine injection. METHODS: This randomized, double-blinded study included fifty-six patients scheduled for elective arthroscopic rotator cuff repair. Normal saline (group C) or 0.5 mg/kg of ketamine (group K) was injected intravenously before the skin incision. An intra articular injection using 20 ml of 0.75% ropivacaine was performed in both groups just before wound closure by the surgeon at the end of the surgery. Postoperative pain was assessed by the numeric rating scale (NRS) in the post-anesthesia care unit (PACU) and at 12, 24, and 48 hours postoperatively. The total dose of fentanyl consumption and side effects were recorded. RESULTS: There were no significant differences between the C and K groups for the NRS of pain in the PACU and at 12, 24, and 48 hours after the surgery. In addition, there was also no significant difference in total fentanyl consumption between the two groups. CONCLUSIONS: Preemptive ketamine did not reduce preemptive pain scores and fentanyl consumption in patients who underwent arthroscopic rotator cuff repair with intra articular local anesthetic injection. Therefore, more aggressive and multimodal pain control is required in patients undergoing arthroscopic shoulder surgery regardless of the use of preemptive intravenous ketamine injection.
Central Nervous System Sensitization ; Fentanyl ; Humans ; Ketamine* ; Pain, Postoperative* ; Rotator Cuff* ; Shoulder ; Skin ; Wounds and Injuries

These days, the frequency of electrical injuries is increasing with the increased spread of electricity use. Electrical injuries cause various complications, ranging from a local superficial skin injury to extensive internal organ damage, including essential vital organs, such as the cardiovascular or central nervous system. We encountered the patient who collapsed after an electrical injury on the scene and was resuscitated successfully after the prehospital early recognition of ventricular fibrillation, and rapid defibrillation, followed by post cardiac arrest care in the hospital. Prehospital early electrocardiogram monitoring and defibrillation may be needed in electrical injured patients.
Central Nervous System ; Electric Injuries ; Electricity ; Electrocardiography ; Heart Arrest ; Humans ; Skin ; Ventricular Fibrillation*

In treating deep second degree burn, it is important to induce reepithelization as soon as possible. So it is crucial to remove eschar after appropriate anesthesia. But in case of extensive wound area or anxiety of needle, we have been used topical anesthetics alternative to lidocaine injection based on its efficacy and safety. Even though it is rare but, we experienced a patient who suffered Central nervous system toxicity following topical anesthetics of lidocaine application. So we report a case with review of related articles.
Anesthesia ; Anesthetics* ; Anxiety ; Burns ; Central Nervous System* ; Humans ; Lidocaine ; Needles ; Wounds and Injuries

Recent attention has focused on the use of stem cells for therapy following ischemic stroke. Our understanding of brain injury following ischemic stroke has benefitted from a number of studies elucidating the causes and pathways leading to neuronal injury and death after anoxic insult. Other paths of research have provided the technology to create and manipulate stem cells along specific neuronal pathways. Therefore, researchers and clinicians have begun basic studies in the use of stem cell therapies to limit injury to the central nervous system and repair and regenerate injured neural tissues following hypoxia due to stroke. These therapies are showing promise and potential in improving the outcome of the stroke patient. This review covers our current knowledge and views concerning mechanisms of tissue damage following ischemic stroke, and the mechanisms by which stem cell therapy is predicted to benefit patients facing potential brain damage and loss of function. Recent reports of clinical trials using stem cells for stroke therapy are evaluated and critical points requiring further work and research are discussed.
Anoxia ; Brain ; Brain Injuries ; Brain Ischemia ; Central Nervous System ; Humans ; Neurons ; Stem Cells ; Stroke