BACKGROUND: After multiple trauma, blood coagulation activity is enhanced and fibrinolytic activity is suppressed by overproduction of plasminogen activator inhibitor-1 (PAI-1). Intermittent sequential pneumatic compression (ISPC) is an effective method to prevent deep vein thrombosis. Its action is explained by the mechanical effect on blood flow, as well as by the enhancement of fibrinolysis by the reduction of PAI-1. The aim of this study was to determine the effects of ISPC on coagulation and fibrinolysis after multiple trauma. METHODS: Thirty-nine trauma patients were either treated with ISPC (ISPC group, 20 patients) or without ISPC (control group, 19 patients). We measured the plasma levels of the thrombin antithrombin III complex (TAT), the plasmin alpha 2 plasmin inhibitor complex (PIC), the tissue plasminogen activator (t-PA), and the plasminogen activator inhibitor-1 (PAI-1) on admission and at 1, 2, 3, 6, 12, and 24 hours after admission. RESULTS: The TAT was higher than normal in both groups, with no significant difference between the two groups throughout the study period. The PIC level of ISPC group was significantly higher than that of the control group. In the ISPC group, the PIC level increased gradually, reaching a peak at 3 hours and decreasing thereafter. In the control group, the PIC level increased to a peak level at 2 hours. The TAT/PIC ratio dropped in the first two hours and increased at 3 hours, dropping again thereafter. In the ISPC group, the ratio dropped gradually without an intermittent fluctuation. At 3 and 6 hours, the control group showed a significantly greater ratio compared to the ISPC group. PAI-1 was higher than normal in bothgroups, with a significantly lower level in the ISPC group from 2 hours to 24 hours. For the t-PA level, no difference was noted between the two groups, with the peak level occurring at 1 hour. The PAI-1/t-PA ratio was significantly greater in the control group from 2 hours to 12 hours than in the ISPC group, but the difference was not significant at 24 hours. CONCLUSIONS: In multiple trauma patients, ISPC does not seem to affect coagulation, but enhances fibrinolysis through suppressed PAI-1 production. This effect of ISPC may be maintained for 12 hours.
alpha-2-Antiplasmin ; Antithrombin III ; Blood Coagulation ; Fibrinolysin ; Fibrinolysis* ; Humans ; Multiple Trauma* ; Plasma ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Thrombin ; Tissue Plasminogen Activator ; Venous Thrombosis

This study was carried out to investigate the direct neurotoxicity of alcohol on CNS and the effects of piracetam or vitamins on ultrastructural changes of the rat cerebellar and hippocampal neurons during long-term alcohol treatment. To evaluate the results, quantitative analysis were done for light and electronic microscopic findings. On the light microscopy, red degeneration of pyramidal cells and Purkinje cells was found more apparently in the alcohol only treated group than in the control group. On the electron microscopy, increased lipofuscin pigments wee found in cerebellum and hippocampus. In quantitative analysis, vitamins significantly reduced red degeneration in both hippocampus and cerebellum. However, piracetam significantly reduced red degeneration in cerebellum but not in hippocampus. Lipofuscin pigments in Purkinje cells and pyramidal cells were significantly reduced in the alcohol with piracetam treated group than the alcohol only treated group. However, vitamin had no significant reducing effect of lipofuscin pigments in Purkinje cells and pyramidal cells. According to the results, it is concluded that vitamins deficiency might cause red degeneration of pyramidal cell after long-term alcohol treatment, but increment of lipofuscin pigments in pyramidal and Purkinje cell may be caused by alcohol itself or its metabolite rather than vitamins deficiency. Piracetam seems to improve cognitive function impairment caused by alcohol consumption.
Alcohol Drinking ; Animals ; Cerebellum ; Hippocampus ; Lipofuscin ; Microscopy ; Microscopy, Electron ; Neurons* ; Piracetam* ; Purkinje Cells ; Pyramidal Cells ; Rats* ; Vitamins*

No abstract available.
Child* ; Colon* ; Constipation* ; Enema* ; Fecal Incontinence* ; Humans

The management of penetrating injuries of zone II of the neck presents a difficult problem. The difficulties are due to the close anatomical relationships between the many vital structures in the neck and to the insidious nature in which some of the injuries may present themselves, for example, esophageal lacerations. If a significant injury is overlooked, the consequences may be dire with severe complication and mortality. Two management strategies have been developed for coping with these difficult injuries : (1) mandatory exploration of all injuries penetrating the platysma, and (2) a selective approach with neck exploration being performed based on clinical and investigative findings. The aim of this study was to review the clinical characteristics of and the various treatment protocols for II penetrating injuries of the neck. We reviewed retrospectively the medical records of 38 patients who were admitted to and treated at Yongdong Severance Hospital, College of Medicine, Yonsei University, due to penetraing injuries of the neck from Jan. 1990 to Dec. 1996. Twenty-three of the 38 patients (60.5%) underwent immediate operative exploration. In 13 of these patients, the exploration produced positive findings (56.5%), and in 10, the exploration produced negative findings (43.5%). Following neck exploration, 13 patients presenting acutely were found to have 21 injuries. The predominant injuries were vascular followed by neurologic and then respiratory. Eight of the 11 patients (73%) with positive clinical findings were found to have injuries at exploration, and 5 of the 12 patients (42%) with no clinical signs were found to have injuries (p=0.0432). Three of 4 patients (75%) with positive CT scan findings were found to have injuries at exploration and 4 of the 8 patients (50%) with no CT scan findings were found to have injuries (p=0.0455). The complication rate and the performance rate of CT scan were not statistically different between patients with a negative neck exploration and patients with conservative management. The duration of hospitalization was an average of 6.2 days for those patients with a negative neck exploration and 4.1 days for those patients with conservative management (p=0.0022). There was no mortality. In conclusion, it is possible, by careful physical examination and CT scan, it will be possible to reduce the rate of negative neck exploration without risk to those patients who need immediate surgery.
Clinical Protocols ; Hospitalization ; Humans ; Lacerations ; Medical Records ; Mortality ; Neck Injuries* ; Neck* ; Physical Examination ; Retrospective Studies ; Tomography, X-Ray Computed ; Wounds, Penetrating

No abstract available.
Busan* ; Child* ; Humans ; Mass Screening* ; Urinary Tract*

No abstract available.
Busan* ; Child* ; Humans ; Mass Screening* ; Urinary Tract*

No abstract available.

A total of 110 computed tomographic scans of the brain in pediatric population were reviewed. They wereretrospectively analyzed focusing on the ventricular dilatation, widening of subdural space in frontal region andprominence of cerebral sulci in hemisphere. The results were compared with clinical recored. In the measurementbicaudate ventricular index waas above 0.18, which ws considered ventricular dilatation. The subdural space in thefrontal region and teh prominent cerbral sulci in the hemisphere were visualized among the cases aged over twoyears with clinical evidence of cerbral problem is pediatric population. The diagnostic application of CT to thecases of cerebral disorder in pediatric population is highly recommended.
Brain ; Dilatation ; Subdural Space

No abstract available.
Mucormycosis

BACKGROUND: The management of penetrating neck injuries presents a difficult problem. Although many authors have stated that surgical exploration should be mandatory for all neck injuries that penetrate platysma, recent reports from many centers now claim selective exploration. The aim of this study was to review a policy of selective neck exploration based on clinical presentation, anatomic location, and the result of diagnostic studies. METHOD: We reviewed retrospectively medical records of 66 patients who were admitted and managed at Yongdong Severance hospital, Yonsei university college of medicine due to penetrating neck injuries from Jan. 1990 to Dec. 1996. RESULTS: Forty-one patients(62%) were underwent immediate neck exploration, while the remaining 25 patients(38%) were admitted and observed. Three had esophagoscopy, four had esophagogram, and three had direct laryngoscopy, all of which revealed normal result except one patient had blood tinged larynx on laryngoscopy. Results of 12 neck explorations(29%) were negative. There was no delayed diagnosis during conservative treatment. There was no mortality. CONCLUSION: We concluded that selective exploration of penetrating neck injuries is both safe and resonable.
Delayed Diagnosis ; Esophagoscopy ; Humans ; Laryngoscopy ; Larynx ; Medical Records ; Mortality ; Neck Injuries* ; Neck* ; Retrospective Studies ; Tolnaftate