We reviewed retrospectively the medical records of 80 consecutive patients with renal injuries, managed at Seoul National University Hospital during a 22 year period from 1965 to 1987. All patients but one who had stab wound presented with a history of blunt injury and the most common cause of injury was fall-down(48%). Renal contusion was most common type of injury(45%) and there were 3 patients(4%) with pedicle injury. All patients presented with hematuria and in 67 patients of 80 the hematuria was gross. Initial diagnostic procedure was excretory urography in 71 patients. Representative cases were illustrated in details. After reviewing and analyzing indications and efficiency of various diagnostic studies in these patients, several conclusions can be made for adequate radiologic plan. In cases of microscopic hematuria without shock, further diagnostic work-up may not be necessary. Computed tomography may be performed initially without excretory urography when multiple or major injuries are suspected. Ultrasonography may be complementary after excretory urography in minor injuries. If findings of excretory urography or ultrasonography were suggestive of major injury or not conclusive, computed tomography is indicated. Angiography may be indicated only when renal pedicle injury is suspected.
Angiography ; Contusions ; Hematuria ; Humans ; Medical Records ; Retrospective Studies ; Seoul ; Shock ; Ultrasonography ; Urography ; Wounds, Nonpenetrating ; Wounds, Stab

PURPOSE: This study was performed to examine if CT classification of renal blunt injury could aid in expectation of hemodynamic stability and clinical decision of whether to intervene surgically. MATERIALS AND METHODS: Over a 80-month period between July 1987 and March 1994, 41 patients were admitted to our hospital with the diagnosis of renal blunt injury. The renal blunt injuries were classified on Fedede's three-point scale CT classification methods :grade I, contusion, intrarenal hematoma, segmental infarction, and small subcapsular hematoma;grade II, complete or incomplete laceration, large subcapsular hematoma, and renal fracture;grade Ill, shattered kidney and renal pedicle injury. Hemodynamic stability, treatment method and clinical outcome of the patients with different CT grade were analyzed retrospectively. RESULTS: All 34 patients with grade I or II CT findings were hemodynamically stable and were successfully managed with conservative method. Among 7 patients with grade III CT findings, 6 patients were hemodynamically unstable. Out of the 6, One patient with grade IIIb or renal pedicle injury was expired before surgical intervention due to ischemic shock. Four patients were intervened surgically with one failure to thrive. The remaining one patient refused to be intervened surgically, and was discharged against medical advice. Only one out of 7 patients was hemodynamically stable and was managed conservatively. CONCLUSION: The patients with grade I or II CT findings are prone to be hemodynamically stable and to be managed with conservative method. But the patients with grade III CT findings are more likely to be hemodynamically unstable. Therefore patients with grade III CT findings should be closely monitored and be pre- pared for the possibility of immediate surgical intervention
Classification* ; Contusions ; Diagnosis ; Failure to Thrive ; Hematoma ; Hemodynamics ; Humans ; Infarction ; Kidney ; Lacerations ; Retrospective Studies ; Shock ; Wounds, Nonpenetrating

From October 1985 to March 1992 we experienced 18 cases of childhood kidney injury. All cases were blunt injury and could be classified as renal contusion (38.9%), minor renal laceration (16.7%). major renal laceration (33.3%) and renal pedicle injury (11.1%). Thirteen patients were treated conservatively and 3 patients were undergone partial nephrectomy and 2 patien1s were undergone nephrectomy. All five cases were classified as major laceration. One patient of major renal laceration was treated conservatively and recovered without delayed operation and functional impairment on follow-up 99Tc-DTPA. Two vascular injured children were treated conservatively owing to delayed identification. The most important clinical sign of severe injury was the rate of hemoglobin decrease (p<0.05). In case of normal IVP and microscopic hematuria, there was no need to further radiologic work-up and it may be treated conservatively without complication or delayed operation. The computerized tomography was the most accurate diagnostic tool in evaluating renal trauma especially in cases of multiple organ trauma. There was no hypertension secondary to renal trauma in 6 patients whose blood pressure was followed up for average 9 months.
Blood Pressure ; Child* ; Contusions ; Follow-Up Studies ; Hematuria ; Humans ; Hypertension ; Kidney* ; Lacerations ; Nephrectomy ; Wounds, Nonpenetrating

OBJECTIVES: To explore the differences in the repair process of skin and skeletal muscle after contusion caused by blunt force attack with different heights. METHODS: Three degrees of contusion were performed on SD rats' right hind limbs by a designed free-dropping device falling from 15, 30 and 50 cm heights, which as a main consideration factor for degree of injury. The repair process of skin and skeletal muscle at 6 h, 24 h, 3 d, 7 d and 13 d after contusion were observed using routine histological methods. RESULTS: Hematoma within skin and/or muscle was found in the rats' hind limbs after contusion with three different heights. The repair processes were similar at 24 h after contusion. However, with the increase of height, the display degree was more obvious. At 3 d after contusion, the RBC of the hemorrhagic region would be decomposed and elapsed in 15 cm contusion group, but for 30 cm contusion group, it delayed to 7 d. At 13 d after contusion, the similar result was found in 15 cm and 30 cm contusion groups, in contrast, the 50 cm contusion group was still in the proliferative phase. CONCLUSIONS With the increase of height, the occurring rate of hematoma within skin and muscle at the same time increases, and the more serious histological appearance after contusion, including inflammation and proliferation, the longer healing process are observed. According to the results of present study and considering forensic application, the contusion model with 50 cm height （2.58 J/cm²） is recommended as the experimental animal model for the future study of wound age estimation on contusion.
Animals ; Contusions/pathology* ; Hindlimb ; Muscle, Skeletal/pathology* ; Rats ; Rats, Sprague-Dawley ; Skin/pathology* ; Wounds, Nonpenetrating

OBJECTIVETo establish an animal model to replicate the blunt impact brain injury in forensic medicine.

METHODSTwenty-four New Zealand white rabbits were randomly divided into control group (n equal to 4), minor injury group (n equal to 10) and severe injury group (n equal to 10). Based on the BIM-II Horizontal Bio-impact Machine, self-designed iron bar was used to produce blunt brain injury. Two rabbits from each injury group were randomly selected to monitor the change of intracranial pressure (ICP) during the impacting process by pressure microsensors. Six hours after injury, all the rabbits were dissected to observe the injury morphology and underwent routine pathological examination.

RESULTSVarying degrees of nervous system positive signs were observed in all the injured rabbits. Within 6 hours, the mortality rate was 1/10 in the minor injury group and 6/10 in the severe injury group. Morphological changes consisted of different levels of scalp hematoma, skull fracture, epidural hematoma, subdural hematoma, subarachnoid hemo- rrhage and brain injury. At the moment of hitting, the ICP was greater in severe injury group than in mild injury group; and within the same group, the impact side showed positive pressure while the opposite side showed negative pressure.

CONCLUSIONSUnder the rigidly-controlled experimental condition, this animal model has a good reproducibility and stable results. Meanwhile, it is able to simulate the morphology of iron strike-induced injury, thus can be used to study the mechanism of blunt head injury in forensic medicine.

The zygomaticomaxillary complex (ZMC) functions as a buttress for the face and is the cornerstone to a person's aesthetic appearance, by both setting the midfacial width and providing prominence to the cheek. Malar deficiency is often acquired by blunt injury incurred in a traumatic accident, resulting in ZMC fracture. A 48-year-old male patient presented a right ZMC fracture after contusion injury by a baseball. He only received conservative management and later he suffered discomfort during mouth opening at the moment of mastication, due to trismus involving the temporomandibular joint. In the current case, we describe a surgical technique, by which the malar body is shifted anteriorly and laterally after combined oblique-vertical osteotomy. The technique presented, eventually restored the former aesthetic position of the malar complex and symmetry, and, moreover, improved mastication function.
Baseball ; Cheek ; Contusions ; Fractures, Malunited ; Humans ; Male ; Mastication ; Middle Aged ; Mouth ; Osteotomy* ; Temporomandibular Joint ; Transplants* ; Trismus ; Wounds, Nonpenetrating

OBJECTIVE: To establish a new animal model of grading skeletal muscle contusions that could be controllable and repetitive. METHODS: The rats' gastrocnemius was injured by a new weight-dropping device designed. The force acting on gastrocnemius with a comparatively constant duration and inducing elastic deformation of the gastrocnemius was expressed with velocity (v) and deformation (DF). Instant velocity was changed to create gastrocnemius contusions. Pathological changes of gastrocnemius were graded by the gross and histological examinations of 39 rats. RESULTS: At low level of impact (v: 2 m/s, DF: 5.5 mm), mild injuries were detected in epimysium and superficial layer of gastrocnemius. At moderate level of impact (v: 2.5 m/s, DF: 6.5 mm), the injuries were observed in epimysium and whole gastrocnemius. At high level of impact (v: 3 m/s, DF: 7.5 mm), severe injuries were seen deeper to soleus with more extensive skeletal muscle damage. CONCLUSION Grading of skeletal muscle blunt force contusion is created by parameter of velocity and muscle deformation. The model could be used for further research on skeletal muscle contusions.
Animals ; Contusions/classification* ; Disease Models, Animal ; Forensic Pathology ; Male ; Muscle, Skeletal/injuries* ; Rats ; Rats, Sprague-Dawley ; Wounds, Nonpenetrating

Pseudoaneurysm arising from the superficial temporal artery (STA) is a rare and potentially critical cause of palpable mass. Most pseudoaneurysms form as a result of blunt trauma and present as painless, pulsatile mass that may be associated with pathologic finding and enlarged size. We report a rare case of pseudoaneurysm arising from STA caused by blunt injury and diagnosed by 3-dimensional computed tomography (CT) angiography.
Aneurysm, False ; Angiography ; Temporal Arteries ; Wounds, Nonpenetrating

Priapism is a pathologic state of persistent penile erection in the absence of sexual stimulation. Low flow priapism is more common, which is caused by a venous outflow obstruction. However, high flow priapism is rare, and is caused by uncontrolled arterial flow into penis following perineal or penile blunt injuries. We report a case of high flow priapism secondary to the treatment of low flow priapism.
Male ; Penile Erection ; Penis ; Priapism* ; Wounds, Nonpenetrating

PURPOSE: Pulmonary contusion is the most common injury in patients with blunt chest trauma, and reported as 15~20% of multiple traumatic patients. In this study, we would like to predict a prognosis for pulmonary contusion easily at ED through the chest CT scanning. METHODS: We reviewed medical records and chest CT findings of 190 pulmonary contusion patients retrospectively. Both lung were devided into 4 areas, RUL +RML, RLL, LUL, and LLL (RUL: right upper lobe, RML:right middle lobe, LUL:left upper lobe, LLL: left lower lobe). 3 point were given to each area, maximally. In each area, a ratio was measured as the longest pulmonary contusion length per the transverse axis length of lung on the largest pulmonary contusion image of chest CT scan. The score can be obtained by multiplying 3 to the ratio and raising fractions not lower than 0.5 to a unit. We classified to three groups as mild (PCS 0-2), moderate (3-5), and severe (6-12) PCS groups. RESULTS: 179 patients with pulmonary contusion were classified as 94 mild, 52 moderate, 33 severe pulmonary contusion groups by PCS. As PCS was high, PRF (Pao2/ FiO2) was decreasing, number of patients treated with mechanical ventilation was increasing, ICU stay was long, and a complication rate was increasing. CONCLUSION: For patients with blunt chest trauma at ED which classified as severe PCS group (6-12), the patients need ICU admission and active treatment for a long time to reduce the mortality and complication rate.
Axis, Cervical Vertebra ; Contusions* ; Humans ; Lung ; Medical Records ; Mortality ; Prognosis ; Respiration, Artificial ; Retrospective Studies ; Thorax* ; Tomography, X-Ray Computed* ; Wounds, Nonpenetrating