Age group characteristics of children who visited a regional trauma center and analysis of factors affecting the severe trauma

Purpose@#The aim of this study was to analyze the age group characteristics and factors associated with the severe trauma in children who visited a regional trauma center. @*Methods@#We reviewed children aged 18 years or younger who visited a regional trauma center, equivalent to level 1 trauma centers in the United States, in Incheon, Korea from July 2014 through December 2019. They were classified by the age groups: preschoolers (0-6 years), schoolers (7-12 years), and adolescents (13-18 years). Across the 3 age groups, event profiles, severity, and outcomes of injury were compared. Multivariable logistic regressions were used to identify factors associated with the severe trauma, defined as the Injury Severity Score of 16 or higher. @*Results@#Among the total of 367 children, 74 (20.2%) were preschoolers, 73 (19.9%) were schoolers, and 220 (59.9%) were adolescents. The most common injury mechanisms in the preschoolers, schoolers, and adolescents were fall (40.5%), pedestrian collision (32.9%), and motorcycle accident (38.6%), respectively. The adolescents had the highest median Injury Severity Score (13 [6-23]; P < 0.001). In the multivariable analyses, the Glasgow Coma Scale of 3-8 (odds ratio [OR], 14.60; 95% confidence interval, 5.40-39.42) had the highest OR for severe trauma, followed by injury in the abdomen or pelvic contents (OR, 11.61; 95% confidence interval, 4.66-28.89). @*Conclusion@#In pediatric trauma, the mechanism and severity of injury may differ according to age groups, with the severe trauma associated with injuries to the head and torso. It is advisable to have age group-specific approaches and strategies for injury prevention.

Age group characteristics of children who visited a regional trauma center and analysis of factors affecting the severe trauma

Purpose@#The aim of this study was to analyze the age group characteristics and factors associated with the severe trauma in children who visited a regional trauma center. @*Methods@#We reviewed children aged 18 years or younger who visited a regional trauma center, equivalent to level 1 trauma centers in the United States, in Incheon, Korea from July 2014 through December 2019. They were classified by the age groups: preschoolers (0-6 years), schoolers (7-12 years), and adolescents (13-18 years). Across the 3 age groups, event profiles, severity, and outcomes of injury were compared. Multivariable logistic regressions were used to identify factors associated with the severe trauma, defined as the Injury Severity Score of 16 or higher. @*Results@#Among the total of 367 children, 74 (20.2%) were preschoolers, 73 (19.9%) were schoolers, and 220 (59.9%) were adolescents. The most common injury mechanisms in the preschoolers, schoolers, and adolescents were fall (40.5%), pedestrian collision (32.9%), and motorcycle accident (38.6%), respectively. The adolescents had the highest median Injury Severity Score (13 [6-23]; P < 0.001). In the multivariable analyses, the Glasgow Coma Scale of 3-8 (odds ratio [OR], 14.60; 95% confidence interval, 5.40-39.42) had the highest OR for severe trauma, followed by injury in the abdomen or pelvic contents (OR, 11.61; 95% confidence interval, 4.66-28.89). @*Conclusion@#In pediatric trauma, the mechanism and severity of injury may differ according to age groups, with the severe trauma associated with injuries to the head and torso. It is advisable to have age group-specific approaches and strategies for injury prevention.

Breast Magnetic Resonance Imaging for Assessment of Internal Mammary Lymph Node Status in Breast Cancer / 한국유방암학회지

PURPOSE: The purpose of this study was to assess magnetic resonance imaging (MRI) features of malignant internal mammary lymph nodes (IMLNs) and benign IMLNs in breast cancer patients. METHODS: From 2009 to 2014, the records of 85 patients with IMLNs were archived using MRI report data; 26 patients with small size (long axis diameter <5 mm) nodes were subsequently excluded. The current study evaluated internal mammary lymph nodes in 59 patients who underwent breast MRI for breast cancer staging and for posttherapy follow-up. All MRI findings were retrospectively evaluated. Malignancy was determined based on pathologic examination and positron emission tomography computed tomography findings. Independent t-tests, Mann-Whitney U tests, chi-square tests, and receiver operating characteristics (ROC) curve analysis were used. RESULTS: Among MRI features, there were statistically significant differences between benign and malignant IMLN groups, in short axis length (3.6±1.3 vs. 8.2±2.9 mm, respectively), long axis length (8.1±2.4 vs. 14.5±4.8 mm, respectively), short/long axis ratio (0.45±0.10 vs. 0.59±0.17, respectively), absent fatty hilum (mean, 0% vs. 95%, respectively), and restricted diffusion (15.8% vs. 85.0%, respectively) (p<0.050). Multiplicity and location of intercostal spaces was not different between the two groups. Short axis length was the most discriminative variable for predicting metastatic nodes (area under the ROC curve, 0.951; threshold, 4 mm; sensitivity, 92.5%; specificity, 84.2%). CONCLUSION: Conventional MRI and diffusion-weighted MRI are helpful to detect metastasis of internal mammary lymph nodes in breast cancer.

A Case of Improved Adrenal Insufficiency with Corticostreoid Treatment, Secondary to Adrenal Hemorrhage

The large size and vascularity of the neonatal adrenal glands are vulnerable to traumatic and asphyxial injuries. This condition varies in presentation, which the most common is an abdominal mass alone or mass with jaundice and anemia. Some infants show signs of adrenal insufficiency. Abdomial ultrasonogram is the most valuable diagnostic tool. To result in adrenal insuffiency, hemorrhage must involve both adrenals and at least 90% of the adrenocortical tissue must be destroyed. To affect infant may show signs of hypovolemic shock, electrolyte imbalance and metabolic acidosis. Treatment for adrenal insufficiency must be immediate and vigorous, and consists of intravenous glucose, fluid, and electolyte replacement. And conservative treatment failure is candidate for steroid replacement. We experienced a case of bilateral hemorrhage with adrenal insufficiency, who improved with hydrocortisone.

Successful Treatment of Prenatally Diagnosed Non-Chylous Primary Fetal Hydrethorax: A Case Report / 대한주산의학회잡지

Primary fetal hydrothorax presents a wide spectrum of severity ranging from small harmless effusions to life-threatening thoracic compression. Management of this condition is controversial. We experienced a case of non-chylous primary fetal hydrothorax not associated with hydrops or other malformations. A predominantly unilateral hydrothorax in a fetus was diagnosed by sonography at 31 weeks gestation. Repeated ultrasonographic examinations to detect development of hydrops or progression of intrapleural effusion were used to evaluate the need for intrauterine thoracentesis and to decide the optimal time for delivery. Two thoracenteses were performed. The baby was delivered at 34 weeks. Postnatal intubation was carried out in the baby, and then chest tube placement was performed and resulted in the collection of 805ml of serous fluid. Sustained intubation was necessary for 16 days because of developing respiratory distress as a result of prematurity and recurrent pleural fluid accumulation. The baby did well after postnatal evacuation of the intrapleural fluid. Pre and postnatal investigation to find the pathophysiological mechanism leading to hydrothorax were negative. We conclude that non-chylous primary fetal hydrothorax is generally associated with a favorable outcome.

A Study of Progression to Cerebral Palsy in Premature Infants with Neurosonographic Abnormal Findings

PURPOSE: Although neonatal intensive care and development of obstetrics play a role in improving survival rate in prematurity, cerebral palsy (CP) is still one of the neurologic sequelae. We tried to find what kinds of risk factors in the patients with abnormal neurosonographic findings who developed CP later. This study was performed to predict early enough who will develop CP later and to treat rapidly for rehabilitation. METHODS: The one hundred and forty one infants with intraventricular hemorrhage, cyst, or abnormal increased periventricular echodensity in serial neurosonographic findings were admitted to the neonatal intensive care unit of Gil general hospital from January 1992 to December 1994. Neurosonographic findings in CP group and non-CP group during postpartum 18 months to 54 months were analysed retrospectively. RESULTS: 1) 18 of one hundred and forty one cases with abnormal neurosonographic findings developed CP. The duration of mechanical ventilation of the CP group was 11.6+/-16.1 days. It is significantly shorter than that of the control group (non-CP group : 2.2+/-7.0 day). The duration of oxygen therapy in the CP group was 22.4+/-19.2 days. Which is also significantly shorter than that of the control group (non-CP group : 5.4+/-8.4 day) (P<0.01). 2) Increased periventricular echodensity and the size of the cyst in neurosonographic findings in the CP group is significantly different from those of the non-CP group P<0.01). 3) In CP group (N=18), Increased periventricular echodensity and cyst formation were located most commonly in the parietal region. 4) The grade of the intraventricular hemorrhage in the CP group was significantly different from that in the non-CP group (P<0.01). 5) The neurosonographic findings give the diagnostic accuracy for predicting CP. CONCLUSIONS: We studied the relationship of the abnormal neurosonographic findings, CP, and associated risk factors. In review, By using neurosonographic examination the risk of the development of CP could be predicted, and by early diagnosis of CP the quality of the life of CP-patient could be better.