Journal of Trauma and Injury

A method of bedside urethrography before catheterization in pelvic trauma in Korea: a case report: Hojun Lee, Sung Yub Jeong, Kun Hwang; J Trauma Inj. 2023;36(4):451-453. Published online December 20, 2023; DOI: https://doi.org/10.20408/jti.2023.0047

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Abstract PDF: We introduce a convenient method of urethrography before catheterization for patients with pelvic trauma that can be used in a resuscitation area. A 10-mL syringe without a needle was used. X-ray contrast medium (Iohexol, 300 mg I/mL) was administered through the urethral orifice using a 10-mL syringe without needle and a simple pelvic anteroposterior film was taken (70 kilovolt [peak], 50 mAs). A 36-year-old soldier with a saddle injury from a gun barrel was taken to a trauma center. He had a pelvic fracture and complained of hematuria. Bedside urethrography above described was performed. The anterior urethra showed nonspecific findings, but dye leaked from the posterior urethra. Bedside Foley catheter insertion was attempted, but the catheter could not be advanced past the membranous urethra. Thereafter, suprapubic catheterization was performed. On the day of the injury, iliac artery embolization was carried out. The dislocated sacroiliac joint was also treated using open reduction and internal fixation. On hospital day 7, guidewire Foley insertion was performed. This bedside urethrography technique is simple and useful for pelvic fractures in which urethral injury is suspected.; Summary

Experience of vascular injuries at a military hospital in Korea: Doohun Kim, Soyun Nam, Yoon Hyun Lee, Hojun Lee, Hyun Chul Kim; J Trauma Inj. 2024;37(3):182-191. Published online May 19, 2023; DOI: https://doi.org/10.20408/jti.2022.0041

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Abstract PDF: Purpose
Vascular injuries require immediate surgical treatment with standard vascular techniques. We aimed to identify pitfalls in vascular surgery for trauma team optimization and to suggest recommendations for trauma and vascular surgeons. Methods: We reviewed 28 victims and analyzed the patterns of injuries, methods of repair, and outcomes. Results: Ten patients had torso injuries, among whom three thoracic aorta injuries were repaired with thoracic endovascular aortic repair, one left hepatic artery pseudoaneurysm with embolization, and two inferior vena cava with venorrhaphy, three iliac arteries with patch angioplasty or embolization, and three common femoral arteries with bypass surgery or arterioplasty. Four patients had upper extremity injuries, among whom one brachial artery and vein was repaired with bypass surgery after temporary intravascular shunt perfusion, two radial arteries were repaired with anastomoses, and one ulnar artery was repaired with ligation. One radial artery under tension was occluded. Fourteen patients had lower extremity injuries, among whom one superficial femoral artery and vein was repaired with bypass and concomitant ligation of the deep femoral artery and vein, three superficial femoral arteries were repaired with bypass (two concomitant femoral veins with bypass or anastomosis), one deep femoral artery with embolization, two popliteal arteries with bypass or anastomosis, four infrapopliteal transected arteries, one arteriovenous fistula with ligation, and one pseudoaneurysm with bypass. However, one superficial femoral artery and all femoral veins were occluded. One leg replantation failed. Conclusions: There are potential complications of vascular access during resuscitative endovascular balloon occlusion of the aorta procedures. Vascular repair should be performed without tension or spasm. Preservation of the harvested vein in papaverine solution and blood while using a temporary intravascular shunt is a method of eliminating spasms.; Summary

Pancreaticoduodenectomy as an option for treating a hemodynamically unstable traumatic pancreatic head injury with a pelvic bone fracture in Korea: a case report: Sung Yub Jeong, Yoonhyun Lee, Hojun Lee; J Trauma Inj. 2023;36(3):261-264. Published online December 7, 2022; DOI: https://doi.org/10.20408/jti.2022.0059

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Abstract PDF: Pancreatic trauma occurs in 0.2% of patients with blunt trauma and 5% of severe abdominal injuries, which are associated with high mortality rates (up to 60%). Traumatic pancreatoduodenectomy (PD) has significant morbidity and appreciable mortality owing to complicating factors, associated injuries, and shock. The initial reconstruction in patients with severe pancreatic injuries aggravates their status by causing hypothermia, coagulopathy, and acidosis, which increase the risk for early mortality. A staging operation in which PD follows damage control surgery is a good option for hemodynamically unstable patients. We report the case of a patient who was treated by staging PD for an injured pancreatic head.; Summary

Inhalation injury after a landmine explosion: a case report: Woojung Kim, Donghoon Kim, Sung Yub Jeong, Yoonhyun Lee, Hojun Lee; J Trauma Inj. 2022;35(Suppl 1):S35-S39. Published online June 23, 2022; DOI: https://doi.org/10.20408/jti.2022.0005

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Abstract PDF: Blast injuries are divided into four classes, and inhalation injuries are a quaternary class of blast injuries. An inhalation injury can be critical to the patient due to the possibility of related complications, such as airway obstruction resulting from upper airway edema and pneumonia. Once diagnosed, an inhalation injury should be treated with early intubation, aerosol therapy, and antibiotics as soon as possible. We should suspect this injury in circumstances involving fire and especially bomb attacks in a military setting. Antipersonnel landmines designed to damage the soldier by amputating the leg can cause blast injuries, but their power is limited to the lower extremity. However, we found an inhalation injury in a victim whose leg had been amputated by an antipersonnel landmine. As soon as we suspected an inhalation injury, we intubated the patient to preserve his airway and started acetylcysteine/heparin aerosol therapy. The patient also was treated with proper antibiotics for right lower lung pneumonia that developed as a sequela of inhalation injury. We could extubate the patient without any complications such as airway obstruction on the third day of intensive care, after which the patient was transferred to the general ward for active rehabilitation. This report presents the first known case of inhalation injury due to a landmine explosion.; Summary

Acute methemoglobinemia after a blast injury: a case report: Donghoon Kim, Yoonhyun Lee, Sung Yub Jeong, Hojun Lee; J Trauma Inj. 2022;35(Suppl 1):S15-S17. Published online December 10, 2021; DOI: https://doi.org/10.20408/jti.2021.0089

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Methemoglobin is a structurally modified form of hemoglobin incapable of binding oxygen, and elevated levels of methemoglobin cause tissue hypoxia. Occupational exposure to 2,4,6-trinitrotoluene, commonly called trinitrotoluene, causes methemoglobinemia. This case report describes a 27-year-old male sergeant who developed methemoglobinemia upon exposure to trinitrotoluene after a blast injury while welding the walls of tank shells. This is the first case of its kind in Korea. The patient had multiple burns in his abdomen and open fractures in his right leg. While his body temperature, heart rate, respiratory rate, arterial blood pressure, and chest X-ray were normal, arterial gas analysis revealed acute (methemoglobinemia concentration, 13.5%; oxygen saturation, 92.0%), probably caused by nitroglycerin exposure. Aspiration and adsorption through the skin and respiratory system were suspected to be the routes of entry. His methemoglobinemia normalized after 4 days after treating the wounds surgically, administering oxygen therapy, and performing blood transfusion.

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Methemoglobinemia screening and treatment in tank warfare survivors
Shahar Negev, Shaun Gruenbaum, Amit Frenkel, Alexander Zlotnik, Ohad Gabay
The American Journal of Emergency Medicine.2024; 81: 159.e1. CrossRef

Splenic Autotransplantation after Blunt Spleen Injury in Children: Hojun Lee, Byung Hee Kang, Junsik Kwon, John Cook-Jong Lee; J Trauma Inj. 2018;31(2):87-90. Published online August 31, 2018; DOI: https://doi.org/10.20408/jti.2018.31.2.87

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Non-operative management has been preferred in blunt spleen injury. Moreover children are more susceptible to post-splenectomy infection, spleen should be preserved if possible. However, splenectomy is inevitable to patients with severe splenic injury. Therefore splenic autotransplantation could be the last chance for preserving splenic function in these patients although efficacy has not proven. Here we reported four cases of children who were underwent splenic autotransplantation successfully after blunt trauma.

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Stumpfes Bauchtrauma bei Kindern und Jugendlichen: Behandlungskonzepte in der Akutphase
M. C. Schunn, J. Schäfer, F. Neunhoeffer, J. Lieber, J. Fuchs
Die Chirurgie.2023; 94(7): 651. CrossRef

Rare Imaging of Fat Embolism Seen on Computed Tomography in the Common Iliac Vein after Polytrauma: Hojun Lee, Jonghwan Moon, Junsik Kwon, John Cook-Jong Lee; J Trauma Inj. 2018;31(2):103-106. Published online August 31, 2018; DOI: https://doi.org/10.20408/jti.2018.31.2.103

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Fat embolism refers to the presence of fat droplets within the peripheral and lung microcirculation with or without clinical sequelae. However, early diagnosis of fat embolism is very difficult because the embolism usually does not show at the computed tomography as a large fat complex within vessels. Forty-eight-year-old male with pedestrian traffic accident ransferred from a local hospital by helicopter to the regional trauma center by two flight surgeons on board. At the rendezvous point, he had suffered with dyspnea without any airway obstruction sign with 90% of oxygen saturation from pulse oximetry with giving 15 L of oxygen by a reserve bag mask. The patient was intubated at the rendezvous point. The secondary survey of the patient revealed multiple pelvic bone fracture with sacrum fracture, right femur shaft fracture and right tibia head fracture. Abdominal computed tomography was performed in 191 minutes after the injury and fat embolism with Hounsfield unit of ?86 in his right common iliac vein was identified. Here is a very rare case that mass of fat embolism was shown within common iliac vein detected in computed tomography. Early detection of the fat embolus and early stabilization of the fractures are essential to the prevention of sequelae such as cerebral fat embolism.

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Fat embolism in the popliteal vein detected on CT: Case report and review of the literature
Tucker Burr, Hamza Chaudhry, Cheryl Zhang, Vasilios Vasilopoulos, Emad Allam
Radiology Case Reports.2020; 15(11): 2308. CrossRef

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