The size of pelvic hematoma can be a predictive factor for angioembolization in hemodynamically unstable pelvic trauma

PURPOSE: Unstable pelvic fracture with bleeding can be fatal, with a mortality rate of up to 40%. Therefore, early detection and treatment are important in unstable pelvic trauma. We investigated the early predictive factors for possible embolization in patients with hemodynamically unstable pelvic trauma.METHODS: From January 2011 to December 2013, 46 patients with shock arrived at a single hospital within 24 hours after injury. Of them, 44 patients underwent CT scan after initial resuscitation, except for 2 who were dead on arrival. Nine patients with other organ injuries were excluded. Seventeen patients underwent embolization. A single radiologist measured the width (longest length in axial view) and length (longest length in coronal view) of pelvic hematoma on CT scans. Demographic, clinical, and radiological data were reviewed retrospectively.RESULTS: Among 35 patients with hemodynamically unstable pelvic fracture, 22 (62.9%) were men. Width (P = 0.002) and length (P = 0.006) of hematoma on CT scans were significantly different between the embolization and nonembolization groups. The predictors of embolization were width of pelvic hematoma (odds ratio [OR], 1.07; P = 0.028) and female sex (OR, 10.83; P = 0.031). The cutoff value was 3.35 cm. More embolization was performed (OR, 12.00; P = 0.003) and higher mortality was observed in patients with hematoma width >3.35 cm (OR, 4.96; P = 0.048).CONCLUSION: Patients with hemodynamically unstable pelvic trauma have a high mortality rate. CT is useful for the initial identification of the need for embolization among these patients. The width of pelvic hematoma can predict possible embolization in patients with unstable pelvic trauma.

Clinical Outcomes of Diffuse Axonal Injury According to Radiological Grade

PURPOSE@#Patients with diffuse axonal injury experience various disabilities and have a high cost of treatment. Recent researches have revealed the underlying mechanism and pathogenesis of diffuse axonal injury. This study aimed to investigate the correlation between the radiological grading of diffuse axonal injury and the clinical outcomes of patients.@*METHODS@#From January 2011 to December 2016, among 294 patients with traumatic brain injury, 44 patients underwent magnetic resonance imaging (MRI). A total of 18 patients were enrolled in this study except for other cerebral injuries, such as cerebral hemorrhage or hypoxic brain damage. Demographic data, clinical data, and radiological findings were retrospectively reviewed. The grading of diffuse axonal injury was analyzed based on patient's MRI findings.@*RESULTS@#For the most severe diffuse axonal injury patients, prolonged intensive care unit (ICU) stay (p=0.035), hospital stay (p=0.012), and prolonged mechanical ventilation (p=0.030) were observed. However, there was no significant difference in healthcare-associated infection rates between MRI grading (p=0.123). Massive transfusion, initial hemoglobin and lactate levels, and MRI gradings were found to be highly significant in predicting the duration of unconsciousness.@*CONCLUSIONS@#This study showed that patients with high grade diffuse axonal injury have prolonged ICU stays and significantly longer hospital stays. Deteriorated mental patients with high energy injuries should be evaluated to identify diffuse axonal injuries by using an appropriate imaging tool, such as MRI. It will be important to predict the duration of consciousness recovery using MRI scans.

Effects Of Tooth-Whitening Agent On Enamel And Dentin: A Confocal Laser Scanning Microscopy Study / 대한치과보철학회지

The purpose of this study was to estimate the effect of a bleaching agent on tooth surfaces and to evaluate the resin bond strength according to different surface treatments on bleached teeth.To prepare for the experimental samples,first,extracted human third molars were used and the body portions of the crowns were cut into four equal-sized specimens.Next,each specimen was mounted in an plastic bottle with self-cured resin and highly polished to have them reveal the enamel or dentin surfaces.Then,the enamel(E)and dentin(D)specimens were divided into four; 1) non-bleached,laser-treated(NBLA)group 2)bleached,laser-treated(BLLA)group 3)non-bleached,acid-treated(NBAC)group and 4)bleached,acid-treated(BLAC)group.Here,opales-cence(R)(10%carbamide peroxide)was used for bleaching agent.The treated specimens were observed by confocal laser scanning microscopy and bonded with composite resin for shear bond test. The following results were obtained from this experiment : 1. Compared with the ENB group,the EBL group was shown to be dyed about 20 micrometer deeper with rhodamine B.The DBL group appeared to be caved in at the entry part of the dentinal tubules, was dyed about 20 micrometer deeper and 5 micrometer wider in diameter,compared with the DNB group. 2. In comparison with the EBLAC group,the ENBAC group looked evenly bonded with the resin, while the DNBAC group,compared to DBLAC group,was observed to have its resin tags penetrated about 50 micrometer deeper.Other than those,however,no observable differences between ENBLA and EBLLA group or between DNBLA and DBLLA group were found. 3. At the shear bond test,the ENBAC group was shown to have statistically significant higher shear bond strength than the EBLAC group(p0.05). 4. At the shear bond test,the DNBAC group was shown to have statistically significant higher shear bond strength than the DBLAC group(p0.05). The in vitro observations above suggest that tooth-bleaching procedure brings a certain change on enamel and dentin surfaces and it weakens the shear bond strength with composite resin when the bleached tooth was acid-treated.