Journal of Trauma and Injury

Volume 26(1); March 2013

Original Articles

The Usefulness of the Admission Base Deficit as a Marker of Mortality in Severely Injured Patients with Blunt Trauma: Byung Chul Yu, Min Chung, Gil Jae Lee, Jung Nam Lee; J Trauma Inj. 2013;26(1):1-5.

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Abstract PDF: PURPOSE
The base deficit (BD) at admission in severely injured patients has been shown to predict the adequacy of resuscitation and outcome, but this relationship is not well established in the Korean experience. The purpose of this study was to define the association between arterial blood gas (ABG) values and the mortality for patients with severe blunt trauma at a developing trauma center in Korea.
METHODS
A retrospective review of 415 adult patients with severe blunt trauma was conducted using electronic medical records from Jan. 2010 to Dec. 2011.
RESULTS
A total of 256 patients had ABG drawn within 1 hour of arrival. Patients who expired displayed a higher lactate level (4.86 vs. 3.31, p<0.0001), a worse BD (-7.99 vs. -5.37, p=0.001), and a lower pH (7.31 vs. 7.34, p=0.011) at arrival compared with those who survived. A statistically significant association was also observed between BD and blood product usage (p=0.001).
CONCLUSION
The base deficit at admission is a useful marker of mortality and outcome in severely injured patients with blunt trauma in Korea.; Summary

Sulforaphane Post-treatment Had No Protective Effects in Paraquat-intoxicated Rats: Gui Sang Jang, Jae Hyuk Lee, Kyuseok Kim, You Hwan Jo, Joong Eui Rhee, Kyoungbun Lee, Chan Jong Park, Chang Woo Kang, Soohoon Lee, Joonghee Kim; J Trauma Inj. 2013;26(1):6-13.

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Abstract PDF: PURPOSE
Sulforaphane is a naturally-occurring isothiocyanate abundant in broccoli. It has been suggested as a promising antioxidant. In this study, the therapeutic effect of sulforaphane in paraquat intoxication was investigated.
METHODS
Paraquat was administered via the tail vein, after which sulforaphane or a vehicle (4% DMSO) was administered intraperitoneally 15 minutes after paraquat administration. Histological injury, lipid peroxidation, plasma cytokine (IL-6, IL-10), and nitric oxide were measured. In addition, the effect of sulforaphane on survival in paraquat-intoxication was observed.
RESULTS
Regarding histological injury, lipid peroxidation, and plasma cytokine and nitric-oxide response, sulforaphane administration showed no protective effects in paraquat-intoxicated rats. Rather, it increased mortality (log rank p=0.03) and caused lipid peroxidation, as well as plasma cytokine and nitric-oxide production, to be increased.
CONCLUSION
Sulforaphane had no therapeutic effect on paraquat-intoxicated rats; rather, it increased mortality.; Summary

Case Reports

Early Definitive Closure of an Open Abdomen by Using Porcine Dermal Collagen Graft: A Case Report: Sung Jin Park, Jae Hun Kim, Sung Pil Yun, Sun Woo Choi, Seon Hee Kim; J Trauma Inj. 2013;26(1):14-17.

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Abstract PDF: PURPOSE
The open abdomen is now the standard of care in various clinical situations, especially it is used to treat abdominal compartment syndrome. Many techniques have been reported for closure after an open abdomen, but most take a long time for complete definitive closure and are associated with various problems. We describe a technique using biologic mesh that can achieve early definitive closure after an open abdomen.
METHODS
A 45-year-old man presented to the emergency room with a painful hip and painful lower extremities after a fall from 80 feet. Radiologic examination revealed multiple fractures of the pelvis and low extremities. Abdominal compartment syndrome caused by a retroperitoneal hematoma developed during the orthopedic surgery. We performed exploration immediately and closed abdomen temporarily. A peritoneal graft of porcine dermal collagen with anterior myofascial approximation of the rectus abdominis muscles and sliding skin flap was performed three days after the previous surgery.
RESULTS
There were no complications related to the wound. The patient was transferred to the Department of Orthopedic Surgery seven days after the initial surgery.
CONCLUSION
Early definitive closure using porcine dermal collagen is a feasible method that can reduce the length of hospitalization and the number of operations for an open abdomen.; Summary

A Case of a Traumatic Pancreatic Neck Transection Treated with a Binding Pancreaticogastrostomy: Young Hoon Sul, Sang Il Lee, Kwang Sik Cheon, In Sang Song; J Trauma Inj. 2013;26(1):18-21.

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Abstract PDF: Pancreatic injury following blunt abdominal trauma is rare, but it has high morbidity and mortality. Various treatments have been attempted, but none has yet been clearly established. The pancreatic neck transection is usually managed by using a distal pancreatectomy with or without a splenectomy. However, pancreatic insufficiency and the risk of post-splenectomy infection remain significant problems. To avoid these problems in patients with a pancreatic neck transection, one may use a pancreaticoenteric anastomosis as a treatment option, but a pancreatic fistula from the pancreaticoenteric anastomosis remains a significant cause of morbidity and mortality. Recently, several reports proposed the binding pancreaticogastrostomy to minimize the possibility of a postoperative pancreatic fistula developing after pancreatic surgery. Thus, we report a case of a traumatic pancreatic neck transection successfully treated with a binding pancreaticogastrostomy.; Summary

Successful Treatment of a Traumatic Hepatic Arterioportal Fistula: A Case Report: Yun Su Mun, Oh Sang Kwon, Jang Young Lee, Gyeong Nam Park, Hyun Young Han, Min Koo Lee; J Trauma Inj. 2013;26(1):22-25.

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Abstract PDF: Severe blunt abdominal trauma frequently involves the liver. The development of nonsurgical treatment of liver trauma has led to more frequent appearance of unusual complications. A hepatic arterioportal fistula (APF) is a rare complication of liver trauma. We present a case of traumatic APF in a patient with liver trauma. A 31-year-old male visited our emergency department with pain in the right upper abdomen following a traffic accident. Initial physical exam and abdominal computed tomography (CT) revealed liver laceration with hemoperitoneum. An abdominal CT obtained on day 11 revealed early opacification of the right portal vein on the arterial phase. After we had come to suspect an APF of the liver, its presence was confirmed on angiography. It was subsequently managed by using transcatheter coil embolization. In patients with portal hypertension and no evidence or history of cirrhosis, one should consider an APF as a potential etiology if history of liver biopsy or penetrating trauma exists. In a patient with liver trauma, serial abdominal CT is important for early detection and treatment of an APF.; Summary

A Case for Chest Wall Panetrating Injury by Nail Gun: Jae Jin Kim, Jin Hui Paik, Ji Hye Kim, Seung Baik Han, Sung Hyun Yun, Jun Sig Kim, Hyun Min Jung; J Trauma Inj. 2013;26(1):26-29.

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Abstract PDF: We describe the case of a 56-year-old man who had been shot by a pneumatic nail gun in the chest during work. He had removed the nail by himself immediately at the accident field. He visited to the emergency department of a local hospital and, after a simple dressing and simple history had been taken, he was referred to our emergency department for penetrating thoracic injury. Immediately, Transthoracic echocardiography were done and showed moderate hemopericardium. Patient had been hydrated and transported to the operating room. After cardiac wound repaired by midsternotomy, the patient was discharged on the 13th postoperative day without complications except mild mitral valve regurgitation.; Summary

Congenital Defects of the Atlantal Arch Presenting Incidentally after Trauma: Seung Taeck Rhee; J Trauma Inj. 2013;26(1):30-33.

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Abstract PDF: A 55-year-old woman was seen in the emergency department with posterior neck pain and a headache after a traffic accident. Physical examination revealed tenderness on palpation over the posterior skull and a midline spinous process of the cervical spine without neurologic deficit. A plain radiograph of the cervical spine demonstrated the absence of the lateral portion of the posterior arch of the atlas and very lucent shadowing of the anterior midline of the atlas, suggesting a fracture of the anterior arch. On three-dimensional computed tomography (CT) of the cervical spine, anterior and posterior bony defects of the atlas were noted. Well-corticated defects were noted with sclerotic change and with no evidence of soft tissue swelling adjacent to the bony discontinuities, consistent with a congenital abnormality. With conservative therapy, the patient gradually showed a lessening of the midline tenderness. Careful investigation with radiography or CT is needed for these patients to avoid confusion with a fracture, because these patients seldom need surgical treatment.; Summary

Trivial Trauma and Non Pathological Delayed Splenic Rupture: A Case Report: Kwang Min Kim, Kuk Jin Kim, Hyun Chul Kim; J Trauma Inj. 2013;26(1):34-37.

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Abstract PDF: Although a majority of patients with splenic rupture present acutely, up to 15% present with a delayed rupture days to weeks following a substantial abdominal injury. The mortality for patients presenting with acute splenic rupture is approximately 1% whereas that associated with delayed rupture approaches 15%. Although many cases of delayed splenic rupture have been reported, the majority of those reports present delayed splenic rupture associated with an underlying systemic disorder such as liver or kidney disease, or another hematologic disorder. We found a delayed splenic rupture case that documented the normal spleens of young healthy soldiers after trivial abdominal trauma, and we have had successful treatment experience with delayed rupture of a normal spleen after trivial trauma. Therefore, we want to review the literature and discuss the phenomenon of delayed rupture of the spleen following trivial trauma.; Summary

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