The often quoted statement that children are not simply small adults remains the central premise of pediatric trauma care. Although multiple traumas remain the leading cause of death among children, fewer resources and less attention have been directed to the treatment of an injured child than to that of an injured adult. Insufficient training of medical personnel and lack of expertise in the management of injured children might be the key factors contributing to the disability and deaths in such children. Although the principles of resuscitation of injured children are similar to those for adults, the basic concepts of advanced life support that have been used for adults remain applicable and critical for injured children. However, we need to know the differences in cardiorespiratory variables, airway anatomy, response to blood loss, and thermoregulation, and special equipments are essential for successful initial resuscitation. Cerebral, abdominal, and thoracic injuries are still the major causes of mortality, morbidity, and disability among traumatized children. Brain parenchymal damage is caused by secondary injuries, such as hypovolemia and hypooxygenemia, are sometimes preventable and intracranial pressure should be maintained within the normal range. The efforts to keep the spleen in children with trauma may make the management of abdominal trauma complicated. Although children seem to be small and weak, our efforts and skill for pediatric life support will make a good result.
Adult ; Body Temperature Regulation ; Brain ; Cause of Death ; Child ; Humans ; Hypovolemia ; Intracranial Pressure ; Multiple Trauma ; Reference Values ; Resuscitation ; Spleen ; Thoracic Injuries

To observe the change in the status of stresses according to three different postural angulation of an intervertebral disc with or without nucleus pulposus, 6 specimens of a 3-dimensional photoelastic model of the spine were made of epoxy. The nucleus pulposus portion was replaced with silicon in three models, and the three were made without silicon. Through axial application of a vertical compressive load of 8 kg, the peculiar patterns of the isochromatic fringes were observed. Stresses on the intervertebral disc were analyzed according to three different postural angulations of the intervertebral disc with the nucleus pulposus and without the nucleus pulposus. The results of these study are as follow: 1. In an erect neutral posture with the nucleus pulposus, the stress concentration was much increased at the posterior portion rather than at the anterior portion. Also, the high stress was concentrated at the medial and central portion. In an erect neutral posture without the nucleus pulposus, the stress concentration was much increased at the anterior portion rather than at the posterior portion and the stress distribution seemed to be locally concentrated. 2. In a maximal flexed posture, the stress concentration was much increased at the posterior portion rather than at the anterior portion. Comparing the presence of the nucleus pulposus with the absence of the nucleus pulposus, the stress concentration was lower at the anterior portion in the presence of the nucleus pulposus than in the absence of the nucleus pulposus. However, the stress distribution at the posterior portion was nearly same in the two groups. According to the analysis of the stress distribution diagram, as a whole, the stress pattern around the disc was evenly distributed. 3. In a maximal extended posture, the higher concentration of the stress distribution at the anterior and medial portion rather than in the posterior and lateral portion was observed. The stress concentration was higher in the presence of the nucleus pulposus than in the absence of the nucleus pulposus. 4. Comparing the maximal flexed posture with the erect neutral posture, the stress concentration in the flexed posture was much decreased in the posterior portion rather than in the erect neutral posture, and an even distribution of the stress pattern in the flexed posture was observed. 5. In the presence of the nucleus pulposus, at the anterior and posterior portion, the stress concentration in the flexed posture was much decreased compared with the extended posture. In the absence of the nucleus pulposus, at the anterior and posterior portion, the stress concentration in the extended posture was much decreased compared with the flexed posture.
Intervertebral Disc* ; Posture ; Silicon ; Spine

When man first walked on this planet, injury must have been a close encounter of the first kind. The outbreak of World War I, during a period of rapid scientific growth in the basic sciences, demonstrated the need to develop better methods of care for the wounded, methods that were later applicable to the civilian population. Trauma is a multisystem disease and, as such, benefits from almost any advance in medical science. As we learn more about the physiology and the biochemistry of various organ systems, we can provide better management for trauma victims. Improved imaging techniques, better appreciation of physiologic tolerance, and increased understanding of the side effects of specific surgical procedures have combined to reduce operative intervention as a component of trauma patient care. On the other hand, because of this rapid development of medical science, only a few doctors still have the ability to treat multisystem injuries because almost doctor has his or her specialty, which means a doctor tends to see only patients with diagnoses in the doctor's specialty. Trauma Surgeons are physicians who have completed the typical general surgery residency and who usually continue with a one to two year fellowship leading to additional board certification in Surgical Critical Care. It is important to note that trauma surgeons do not need to do all kinds of operations, such as neurosurgery and orthopedic surgery. Trauma surgeons are not only a surgeon but also general medical practitioners who are very good at critical care and coordination of patient. In order to achieve the best patient outcomes, trauma surgeons should be involved in prehospital Emergency Medical Services, the Trauma Resuscitation Room, the Operating Room, the Surgical Intensive Care and Trauma Unit, the Trauma Ward, the Rehabilitation Department, and the Trauma Outpatient Clinic. In conclusion, according to worldwide experience and research, the trauma surgeon is the key factor in the trauma care system, so the trauma surgeon should receive strong support to accomplish his or her role successfully.
Ambulatory Care Facilities ; Biochemistry ; Certification ; Critical Care ; Emergency Medical Services ; Fellowships and Scholarships ; Hand ; Humans ; Internship and Residency ; Neurosurgery ; Operating Rooms ; Orthopedics ; Patient Care ; Planets ; Resuscitation ; Trauma Centers ; World War I

In an effort to develop novel mushroom-derived anti-obesity nutraceuticals, water and ethanol extracts containing the lipaseinhibitory compound from Phellinus linteus were prepared, and their nutritional components were determined. The optimal conditions for the extraction of P. linteus lipase inhibitor involved the treatment of the fruiting bodies with distilled water at 80degrees C for 72 hr and 80% ethanol at 100degrees C for 60 hr, respectively. The distilled water extract and ethanol extract contained 10.9% and 6.11% of crude protein, and 0.96% and 15.86% of crude fat, respectively. Additionally, the distilled water extract contained a large quantity of minerals, including 239.5 mg of K, 39.3 mg of Mg, and 39.3 mg of Na. The free amino acid content of the distilled water extracts was also higher than that of the ethanol extracts, and in particular, the distilled water extracts contained 5,139 mg of asparagine, 3,891 mg of tryptophan, 2,598 mg of alanine, and 2,066 mg of serine in 100 g of the distilled water extracts. 100 g of the distilled water and ethanol extracts were found to contain 12.31 g and 8.16 g of malic acid, respectively.
Alanine ; Asparagine ; Dietary Supplements ; Ethanol ; Fruit ; Lipase ; Malates ; Minerals ; Serine ; Tryptophan ; Water

No abstract available.
Cisplatin* ; Drug Therapy* ; Humans ; Ifosfamide* ; Paclitaxel*

To develop a potent anti-obesity lipase inhibitor from mushroom, the lipase inhibitory activities of various mushroom extracts were determined. Methanol extracts from Phellinus linteus fruiting body exhibited the highest lipase inhibitory activity (72.8%). The inhibitor was maximally extracted by treatment of a P. linteus fruiting body with 80% methanol at 40degrees C for 24 hr. After partial purification by systematic solvent extraction, the inhibitor was stable in the range of 40~80degrees C and pH 2.0~9.0. In addition to lipase inhibitory activity, the inhibitor showed 59.4% of superoxide dismutase-like activity and 56.3% of acetylcholinesterase inhibitory activity.
Acetylcholinesterase ; Agaricales ; Fruit ; Hydrogen-Ion Concentration ; Lipase ; Methanol ; Superoxides

PURPOSE: To study whether preoperative fasting would influence postoperative prognosis and to measure the variation of the ketone body amount and ketone body ratio, kidney function during the postoperative period in the model of 90% hepatectomy. MATERIALS AND METHODS: Total of 180, seven weeks old, male, specific pathogen free Sprague-Dawley rats, divided into two groups of the fasted and the fed. First, 80 rats were divided into two groups of 40 each; 40 of that were denied food for 48 hours before the operation, other 40 were fed. Following 90% hepatectomy they were investigated by Kaplan-Meier method, drawing a survival curve. Secondly, 100 rats were divided into two groups of 50 each, 50 of that were denied food for 48 hours before the operation, and the other 50 were fed. Following 90% hepatectomy, they were investigated by the method of Student's T-test and Mann-Whitney test on the following: the amount of arterial ketone body in the blood in the blood sampled from abdominal aorta, reading at preoperative 48 hours, at the time of operation, postoperative 6 hours, 12 hours, 24 hours, 48 hours periods. RESULTS: The mean survival time after operation: the fasted group was 53.0+/-3.7 hours and the fed group was 34+/-1.7 hours and it had the statistical significance(p=0.0008). Rats which had long term survival over 72 hours were 14(35%) in fasted group, but only 2(5%) in fed group. In preoperative fasted group arterial ketone body ratio was recovered earlier than fed group and ketone body amount elevated, but in preoperative fed group, there was no significant change in ketone body amount. Blood glucose level lowered in both groups. Blood ammonia was severely increased in preoperative fed group, suggested bad liver function and destruction of muscle. BUN and blood creatinine was elevated in preoperative fed group, suggested lowered kidney function. CONCLUSION: Preoperative fasting has a positive influence on survival of the rats which has acute liver failure induced by 90% hepatectomy, because it could be caused by increased ketone body amount by preoperative fasting.
Ammonia ; Animals ; Aorta, Abdominal ; Blood Glucose ; Creatinine ; Fasting* ; Hepatectomy* ; Humans ; Kidney ; Liver ; Liver Failure ; Liver Failure, Acute ; Male ; Postoperative Period ; Prognosis ; Rats* ; Rats, Sprague-Dawley ; Specific Pathogen-Free Organisms ; Survival Rate

PURPOSE: The prognosis following colonic perforation is generally regarded as worse than it is for upper gastrointestinal perforation. Moreover, the increasing incidence of colon cancer associated perforation is another reason for the present study of colonic perforation in the present study. We reviewed and analyzed various types of colonic perforations to determine which prognostic factors were still useful for the treatment of colonic perforation. METHODS: Thirty six patients (mean age, 51.5; 24 males) with generalized peritonitis secondary to a colonic perforation were studied retrospectively. All the patients had undergone an exploratory laparotomy. The severity of the clinical condition was recorded according to the APACHE III scoring system for all the patients when they were first seen. Mortality and morbidity were analyzed for possible prognostic factors, such as age, type of operation, association with malignancy, and APACHE-III score. RESULTS: Penetrating trauma was the leading cause of perforation (27.8%), and iatrogenic perforations accounted for 19.4% of the total. Among nontraumatic perforations, malignancy was the major pathology (25.0%). The sigmoid colon was the most frequent site of perforation. Types of surgical treatment varied according to the general conditions of the patients. In 22 patients, the operation was finished with primary closure alone. A colonic resection was performed in 14 patients, and a proximal diversion was performed in 19 patients (after either a resection or primary closure). Analysis of the various clinical variables showed that old age (>60), underlying malignancy, and the APACHE III score were significant prognostic factors for the surgical outcome. CONCLUSIONS: These results suggest that penetrating injuries are still the main cause of colonic perforation and that iatrogenic and malignancy-related perforations are increasing. Among other variables, old age, underlying malignancy and the APACHE III score are significant prognostic factors for the surgical outcome.
APACHE ; Colon* ; Colon, Sigmoid ; Colonic Neoplasms ; Humans ; Incidence ; Laparotomy ; Mortality ; Pathology ; Peritonitis* ; Prognosis ; Retrospective Studies

PURPOSE: The incidence of multiple trauma is increasing nowadays and is the leading cause of death among young adults. Initial treatment is well known to be crucial in multiple trauma victims. However, many indiscriminate transfers occur due to the lack of a well-organized trauma system in Korea. The objective of this study is to demonstrate the current serious state in which major trauma patients are transferred to the Emergency Medical Center of a university hospital from another medical center. METHODS: From November 2009 to October 2010, we performed a retrospective study to analyze the characteristics of patients who visited the Ajou University Medical Center located in Gyeonggi-do. We evaluated the ISS (injury severity score), and a score over 15 point was identified as major trauma. The major trauma patients were separated into two groups according to the visit route, and the characteristics of each group were analyzed. RESULTS: Among the 88,862 patients who visited to the Emergency Medical Center, trauma patients accounted for 19,950, and 343 of them were evaluated as major trauma patients. Among the 343 patients, 170 patients had been transferred from other medical centers. The proportion of males to females was 3.3:1, and the mean ISS was 22.7. The leading cause of trauma was motor vehicle accidents. Of the total 170 patients, 77.6% were admitted to the Intensive care unit and 36.3% underwent surgery. The 170 patients that had been transferred to our medical center, 78.8% were transferred from Gyeonggi-do, 15.3% were transferred from other regions, and 5.9% were miscellaneous. CONCLUSION: Almost half of the major trauma victims treat at our medical center had been transferred from other medical centers. Establishing a traumatic system, supported by well-organized trauma centers and emergency medical services, that can reduce inappropriate transfers among medical facilities is essential.
Academic Medical Centers ; Cause of Death ; Emergencies ; Emergency Medical Services ; Female ; Humans ; Incidence ; Injury Severity Score ; Intensive Care Units ; Korea ; Male ; Motor Vehicles ; Multiple Trauma ; Retrospective Studies ; Trauma Centers ; Young Adult

Purpose: The goal of this study is to define whether or not preoperative portal vein embolization has any additional role in the total amounts of liver regeneration and functional improvement after major hepatectomy in rat model. In addition, this study is to define obstructive jaundice has any positive or negative effect on it. METHODS: There were a total of 650 rats, divided into three experimental groups. Experiment A was done under the normal liver status, experiment B was done under the obstructive jaundice status, experiment C was done under the external biliary drainaged status. Each experimental group was divided into three groups that had been made by different surgery. One was 70% partial hepatectomy, another was 70% portal vein branch ligation, and the other was 70% portal vein ligation followed by 70% hepatectomy. Each operational group required over 60 rats for serial data collection which was taken at the operation and 6, 12, 24, 48, 72 hours after operation. RESULTS: We finally observed that there was no additional regeneration of remaining liver by doing preoperative portal vein embolization. It was same in obstructive jaundice group and external biliary drainaged group. And also, there was no significant fucntional improvement or deterioration by existence of obstructive jaundice. Conclusion: We conclude it is no worth doing preoperative portal vein embolization for getting additional liver regeneration and obstructive jaundice does not has significant positive or negative effect on liver regeneration and hepatic function in itself.
Animals ; Data Collection ; Hepatectomy ; Jaundice* ; Jaundice, Obstructive ; Ligation* ; Liver Regeneration ; Liver* ; Models, Animal ; Portal Vein* ; Rats* ; Regeneration*