OBJECTIVE: The authors report the microsurgical anterolateral tunnel approach for the treatment of the cervical disc diseases and its postoperative surgical results. METHODS: All surgical procedures followed the method of classical microsurgical anterior discectomy. Small tunnel(7-8mm) was made on the disc space reaching to the posterior longitudinal ligament. The disc materials and bony spurs were removed through this tunnel. Thirty-one patients of cervical disc herniation(24 cases with pure disc herniation, 7 cases with combined cervical spondylosis) were evaluated on the symptoms, conformation in plain X-ray, C-T, and MRI. The follow up time was over 2 years . RESULTS: Postoperatively the result(following the out come scale) was excellent and good in Twenty-nine patients. One with fair result showed remnant disc particle and spur and another one is combined with cord contusion. One patient with lesion in C 3-4 space and two cervicothoracic junction showed excellent result. Two patients with osteoporosis also showed good results. Cervical spine curvature and disc space height were not changed on the plain X-ray and MRI in all patients. Twenty-nine patients were discharged within 3 days after surgery without any postoperative complications. CONCLUSIONS: The microsurgical anterolateral tunnel approach could be indicated for the treatment of patients with cervical disc diseases and with difficulty in achieving interbody fusion(the higher cervical level and cervicothoracic junction, osteoporosis etc.).
Contusions ; Diskectomy ; Follow-Up Studies ; Humans ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Osteoporosis ; Postoperative Complications ; Spine

PURPOSE: To investigate the efficacy and advantages of the lateral approach for internal fixation of the distal humeral shaft fractures. MATERIALS AND METHODS: Twelve patients with distal humeral shaft fractures who underwent open reduction and internal fixation using plate and screws by lateral approach from January, 1997 to May, 2002 were investigated. Postoperative results after a minimum 1 year follow-up were assessed using union rate, elapsed time to union, postoperative complications such as iatrogenic radial nerve palsy, range of motion of the elbow joint. Clinical outcomes were evaluated with Mayo elbow performance scoring system. RESULTS: Union was achieved in all cases. The average time to union was 9 weeks (range, 7~12 weeks). Four cases of preoperative radial nerve palsy were revealed as contusion of the intact nerve and resolved completely by three months. The mean elbow range of motion was from 5 to 138 degrees. The average Mayo elbow performance score was 91 points; 9 cases ranked as excellent and 3 as good. CONCLUSION: Distal humeral shaft fractures can be treated successfully through open reduction and internal fixation using plate and screws. Lateral approach is recommended to stabilize distal humeral shaft fractures without compromising the range of motion of the elbow, and to protect or explore the injured radial nerves easily
Contusions ; Elbow ; Elbow Joint ; Follow-Up Studies ; Humans ; Paralysis ; Postoperative Complications ; Radial Nerve ; Range of Motion, Articular

OBJECTIVE: To analyze the morphological features and forensic pathological characteristics of cardiac ruptures of different causes for their differential diagnosis. METHODS: We analyzed the data of 44 autopsy cases of cardiac rupture from 2014 to 2017 in our institute, including 11 cases caused by blunt violence with intact pericardium, 4 caused by cardiopulmonary resuscitation (CPR), 9 by myocardial infarction, and 20 by aorta dissection rupture.The gross features and histopathological characteristics of cardiac rupture and pericardial effusion were analyzed and compared. RESULTS: Cardiac ruptures caused by blunt violence varied in both morphology and locations, and multiple ruptures could be found, often accompanied with rib or sternum fractures; the volume of pericardial effusion was variable in a wide range; microscopically, hemorrhage and contraction band necrosis could be observed in the cardiac tissue surrounding the rupture.Cardiac ruptures caused by CPR occurred typically near the apex of the right ventricular anterior wall, and the laceration was often parallel to the interventricular septum with frequent rib and sternum fractures; the volume of pericardial blood was small without blood clots; microscopic examination only revealed a few hemorrhages around the ruptured cardiac muscular fibers.Cardiac ruptures due to myocardial infarction caused massive pericardial blood with blood clots, and the blood volume was significantly greater than that found in cases of CPR-induced cardiac rupture ( < 0.05);lacerations were confined in the left ventricular anterior wall, and the microscopic findings included myocardial necrosis, inflammatory cell infiltration, and mural thrombus.Cardiac tamponade resulting from aorta dissection rupture was featured by massive pericardial blood with blood clots, and the blood volume was much greater than that in cases of cardiac ruptures caused by blunt violence, myocardial infarction and CPR ( < 0.05). CONCLUSIONS Hemorrhage, inflammatory cell infiltration, and lateral thrombi around the cardiac rupture, along with pericardial blood clots, are all evidences of antemortem injuries.
Aneurysm, Dissecting ; complications ; Aortic Aneurysm ; complications ; Cardiopulmonary Resuscitation ; adverse effects ; Forensic Pathology ; Heart Rupture ; etiology ; pathology ; Heart Rupture, Post-Infarction ; pathology ; Humans ; Myocardial Contusions ; complications

OBJECTIVE: To analyze risk factors associated with post-traumatic retinal detachment and to identify the cause-effect relationship between retinal detachment and blunt ocular trauma in forensic medical assessment. METHODS: 112 cases of forensic medical examination on post -traumatic retinal detachment were retrospectively analyzed. RESULTS A variety of retinal abnormalities were found in these cases, including tearing of the ora serrata retinae (4.28%), macular perforation (12.50%), small (<90 degrees) nonmacular retinal perforation (56.25%), larger (>90 degrees) retinal perforation (5.00%), and tractive retinal detachment without perforation (11.6%). Proliferative vitreoretinopathy (PVR) was found in 45 eyes examined. In most cases, retinal detachment occurred between 1 week to 2 months after blunt ocular trauma (61.60%), with 83.93% accompanied with severe myopia (>-3.00D) and 52.67% accompanied with vitreous floaters. Of all cases, 41.07% were directly and 52.68% were indirectly resulted from blunt ocular trauma, and the rest (6.25%) showed no association with blunt ocular trauma. CONCLUSION Many risk factors may result in retinal detachment including blunt ocular trauma and other causes. Accurate assessment of the relationship between blunt ocular trauma and retinal detachment is an important part of forensic examination.
Adolescent ; Adult ; Contusions/complications* ; Eye Injuries/complications* ; Female ; Forensic Medicine/methods* ; Humans ; Male ; Middle Aged ; Retinal Detachment/pathology* ; Retrospective Studies ; Time Factors ; Wounds, Nonpenetrating/complications* ; Young Adult

BACKGROUND AND OBJECTIVES: Contusions and lacerations of the auricle are common, but reconstructive procedures are difficult because the auricle has an intricate cartilage framework covered with delicate skin. The purpose of this study was to present therapeutic principles of traumatized auricular laceration. SUBJECTS AND METHOD: The study was performed retrospectively and included 35 traumatized auricular laceration patients. Their wound state, degree of laceration, whether or not had exposure of cartilage, methods of reconstruction used and postoperative complications were analyzed. RESULTS: Multiple laceration was found in 11 patients. Eight of 19 patients who had cartilage exposed had been performed cartilage suture method for alignment. Primary reconstruction was performed for two avulsed subtotal injury patients. Pocket principle technique was used for one patient whose auricle was contaminated and amputated. Postoperative complications were noted as paresthesia, color change, delayed healing, deformity and partial loss of auricle. CONCLUSION: Rapid and active management of traumatized auricular lacerations is important to prevent infection and postoperative complications.
Cartilage ; Congenital Abnormalities ; Contusions ; Ear, External ; Humans ; Lacerations* ; Paresthesia ; Postoperative Complications ; Retrospective Studies ; Skin ; Sutures ; Wounds and Injuries

In 38 patients with traumatic wound dehiscence after cataract surgery, we evaluated the causes and degrees of the injury, surgical methods of repair and the final visual outcome from Aug. 1993 to Apr. 1977. Among 38 patients, twenty-five were men and thirteen were women. In 34 patients, wound dehiscence occurred within one month after cataract surgery. The common causes of wound dehiscence were trauma by the finger or fist (9 patients) and by the contusion (7 patients). But in 16 patients, the exact causes of trauma were not identified. Accompanied ocular findings were prolapsed iris (29 patients) , hyphema (9 patients) , and dislocation of intraocular lens (7 patients). All patients received operations for wound closure, iris reposition, anterior vitrectomy, intraocular lens reposition or removal, and iris partial resection. At the end of follow-up, 27 patients achieved corrected visual acuity 20/40 or over. To prevent wound dehiscence after cataract surgery, we suggest that protective eye shield should be applied at least for a month after surgery.
Cataract* ; Contusions ; Dislocations ; Female ; Fingers ; Follow-Up Studies ; Humans ; Hyphema ; Intraoperative Complications ; Iris ; Lenses, Intraocular ; Male ; Visual Acuity ; Vitrectomy ; Wounds and Injuries*

A clinical observation was made on 29 cases of bladder rupture who were admitted to the Department of Urology, In Je Medical College Paik Hospital in Pusan during the period from June, 1979 to August, 1983. The results are as followings; 1. Of 133 cases of genitourinary tract injury, bladder rupture were 29 cases (21.7%), there composed intraperitoneal bladder rupture 19 cases, extraperitoneal bladder rupture 10 cases. 2. The 29 cases Comprised 19 males and 10 females (male:female=l.9:1). The most prevalent age group of bladder rupture was 20 to 29 years, showing 13 cases of the total cases (44.8%). 3. The causes of bladder rupture were traffic accident observed in 11 cases (37.9%), direct blow 7 cases (24.1%), iatrogenic 4 cases (13.8%), stab wound 3 cases (10.3%) and spontaneous bladder rupture was seen in 1 case (3.5%). 4. The common symptoms and signs of bladder rupture were abdominal pain, lower abdominal distension and gross hematuria, so on. 5. The common associated injuries with bladder rupture were pelvic bone fracture 10 cases (34.5), Cerebral contusion 7 cases (24.1%), rib fracture 4 cases (13.8%), rupture of posterior urethra 3 cases (10.3%), so on. 6. The retrograde cystography was the most likely to accurately diagnose a ruptured bladder, but 1 case was revealed false negative cystograms because of the large hematoma within the pelvic cavity. 7. In all cases, immediate bladder repair and indwelling urethral catheter, with or without suprapubic cystostomy were performed. 8. We experienced postoperative complications such as, voiding difficulty, vesicocutaneous fistula and epididymo-orchitis, etc.
Abdominal Pain ; Accidents, Traffic ; Busan ; Contusions ; Cystostomy ; Female ; Fistula ; Hematoma ; Hematuria ; Humans ; Male ; Pelvic Bones ; Postoperative Complications ; Rib Fractures ; Rupture* ; Urethra ; Urinary Bladder* ; Urinary Catheters ; Urology ; Wounds, Stab

A clinical observation was made on 29 cases of bladder rupture who were admitted to the Department of Urology, In Je Medical College Paik Hospital in Pusan during the period from June, 1979 to August, 1983. The results are as followings; 1. Of 133 cases of genitourinary tract injury, bladder rupture were 29 cases (21.7%), there composed intraperitoneal bladder rupture 19 cases, extraperitoneal bladder rupture 10 cases. 2. The 29 cases Comprised 19 males and 10 females (male:female=l.9:1). The most prevalent age group of bladder rupture was 20 to 29 years, showing 13 cases of the total cases (44.8%). 3. The causes of bladder rupture were traffic accident observed in 11 cases (37.9%), direct blow 7 cases (24.1%), iatrogenic 4 cases (13.8%), stab wound 3 cases (10.3%) and spontaneous bladder rupture was seen in 1 case (3.5%). 4. The common symptoms and signs of bladder rupture were abdominal pain, lower abdominal distension and gross hematuria, so on. 5. The common associated injuries with bladder rupture were pelvic bone fracture 10 cases (34.5), Cerebral contusion 7 cases (24.1%), rib fracture 4 cases (13.8%), rupture of posterior urethra 3 cases (10.3%), so on. 6. The retrograde cystography was the most likely to accurately diagnose a ruptured bladder, but 1 case was revealed false negative cystograms because of the large hematoma within the pelvic cavity. 7. In all cases, immediate bladder repair and indwelling urethral catheter, with or without suprapubic cystostomy were performed. 8. We experienced postoperative complications such as, voiding difficulty, vesicocutaneous fistula and epididymo-orchitis, etc.
Abdominal Pain ; Accidents, Traffic ; Busan ; Contusions ; Cystostomy ; Female ; Fistula ; Hematoma ; Hematuria ; Humans ; Male ; Pelvic Bones ; Postoperative Complications ; Rib Fractures ; Rupture* ; Urethra ; Urinary Bladder* ; Urinary Catheters ; Urology ; Wounds, Stab

OBJECTIVETo investigate the high risk factors related to acute respiratory distress syndrome(ARDS) following serious thoracoabdominal injuries.

METHODSThe clinical data of 282 patients with serious thoracoabdominal injuries were retrospectively studied. Univariate and Cox multivariate regression analysis were used to determine the risk factors related to ARDS following serious thoracoabdominal injuries.

RESULTSThe incidence of ARDS was 31.9% (90/282) in patients with serious thoracoabdominal injuries. The mortality caused by ARDS was 37.8% (34/90). The univariate analysis and multivariate analysis demonstrated that the clinical conditions such as elder age, shock, dyspnea, abnormal arterial blood gas, hemopneumothorax, pulmonary contusion, flail chest, coexisting pulmonary diseases, multiple abdominal injury and high ISS score were the independent high risk factors related to ARDS.

CONCLUSIONThere are many high risk factors related to ARDS following severe thoracoabdominal injuries, which should be detected early and treated timely to decrease the incidence and mortality of A RDS.

Abdominal Injuries ; complications ; Adolescent ; Adult ; Age Factors ; Aged ; Blood Pressure ; Child ; Contusions ; complications ; Female ; Humans ; Male ; Middle Aged ; Respiration ; Respiratory Distress Syndrome, Adult ; etiology ; Risk Factors ; Thoracic Injuries ; complications

PURPOSE: A rib fracture secondary to blunt thoracic trauma continues to be an important injury with significant complications. Unfortunately, there are no definite treatment guidelines for severe multiple rib fractures. The purpose of this study was to evaluate the result of early operative stabilization and to find the risk factors of surgical fixation in patients with bilateral multiple rib fractures or flail segments. METHODS: From December 2005 to December 2008, the medical records of all patients who underwent operative stabilization of ribs for severe multiple rib fractures were reviewed. We investigated patients' demographics, preoperative comorbidities, underlying lung disease, chest trauma, other associated injuries, number of surgical rib fixation, combined operations, perioperative ventilator support, and postoperative complications to find the factors affecting the mortality after surgical treatment. RESULTS: The mean age of the 96 patients who underwent surgical stabilization for bilateral multiple rib fractures or flail segments was 56.7 years (range: 22 to 82 years), and the male-to-female ratio was 3.6:1. Among the 96 patients, 16 patients (16.7%) underwent reoperation under general or epidural anesthesia due to remaining fracture with severe displacement. The surgical mortality of severe multiple rib fractures was 8.3% (8/96), 7 of those 8 patients (87.5%) dying from acute respiratory distress syndrome or sepsis. And the other one patient expired from acute myocardial infarction. The risk factors affecting mortality were liver cirrhosis, chronic obstructive pulmonary disease, concomitant severe head or abdominal injuries, perioperative ventilator care, postoperative bleeding or pneumonia, and tracheostomy. However, age, number of fractured ribs, lung parenchymal injury, pulmonary contusion and combined operations were not significantly related to mortality. CONCLUSION: In the present study, surgical fixation of ribs could be carried out as a first-line therapeutic option for bilateral rib fractures or flail segments without significant complications if the risk factors associated with mortality were carefully considered. Furthermore, with a view of restoring pulmonary function, as well as chest wall configuration, early operative stabilization of the ribs is more helpful than conventional treatment for patients with severe multiple rib fractures.
Abdominal Injuries ; Anesthesia, Epidural ; Comorbidity ; Contusions ; Demography ; Displacement (Psychology) ; Head ; Hemorrhage ; Humans ; Liver Cirrhosis ; Lung ; Lung Diseases ; Lung Injury ; Medical Records ; Myocardial Infarction ; Pneumonia ; Postoperative Care ; Postoperative Complications ; Pulmonary Disease, Chronic Obstructive ; Reoperation ; Respiratory Distress Syndrome, Adult ; Rib Fractures ; Ribs ; Risk Factors ; Sepsis ; Thoracic Wall ; Thorax ; Tracheostomy ; Ventilators, Mechanical