Multilevel Duodenal Injury after Blunt Trauma

Duodenal trauma is an uncommon injury associated with significant mortality and morbidity. Upper gastrointestinal radiological studies and computed tomography may lead to the diagnosis of blunt duodenal trauma. Exploratory laparotomy remains as the ultimate diagnostic test if a high suspicion of duodenal injury continues even in the face of absent or equivocal radiographic signs. The majority of duodenal injuries may be managed by simple repair of the injured site. More complicated injuries require more sophisticated techniques. Here, we report a case of multilevel blunt duodenal injury successfully managed with duodenal diverticulization, Roux-en-Y gastrojejunostomy and catheter duodenostomy.

Pneumatosis Cystoides Intestinalis with Intestinal Volvulus

Pneumatosis cystoides intestinalis is an uncommon condition characterized by the presence of multiple gas-filled cysts within the wall of the gastrointestinal tract. It is still a poorly understood phenomenon, considered to result from primary mucosal insult from varying causes. However, it is associated with various diseases, including gastroenteral obstructive and connective vascular diseases and even pulmonary or endocrine diseases. Authors report a case of pneumatosis cystoides intestinalis with volvulus in the small intestine that developed in a 44-year-old man without history of any special underlying diseases.

Subclavian Steal Syndrome

The definition of subclavian steal is the reversal of vertebral blood flow resulting from the stenosis or occlusion of one of the subclavian arteries or the innominate artery. It is a rare disease resulting in a variety of ischemic neurologic symptoms such as vertigo, dizziness, diplopia, dysarthria, ataxia and nystagmus. Some patients show ischemic symptoms and digital necrosis of the involved arm. Among treatment options, Subclavian to carotid transposition is the most preferred method. We report a patient with subclavian steal syndrome who had 5th finger necrosis of the left hand without neurologic symptoms. It was successfully treated with a carotid-subclavian bypass with a 6 mm ePTFE graft.

A Clinical Study of Traumatic Duodenal Injury

PURPOSE: Traumatic duodenal injury is rare. There is no consensus on what type of repair should be performed for duodenal perforations with respect to their varying severity. As a result, surgeons are confronted with the dilemma of choosing between several diagnostic tests and many surgical procedures. In this study, we report our experience with treating traumatic duodenal injury and also offer a review of the literature. METHODS: Seventeen patients with duodenal injury following abdominal trauma were treated by several methods between January 1992 and October 2006. Based on review of the medical records, we classified the patients as having grade I through V duodenal injury using the scale constructed by the American Association for the Surgery of Trauma (AAST). We also noted clinical features, operative management, and outcome. RESULTS: Among 17 patients, one patient who had a duodenal intramural hematoma was treated by conservative management. Seven patients were treated by duodenojejunostomy, with only one complication. The remaining 9 patients underwent various operations, including primary closure alone (n=3), primary closure with jejunal patch (n=1), primary closure with duodenostomy (n=3), and pancreaticoduodenectomy (n=2). The complication rate among patients who underwent surgery within 24 hours after injury was 1 case among 13. However, complications occurred in all 4 surgical cases undertaken more than 24 hours after injury. CONCLUSION: Early diagnosis (within 24 hours) and thorough inspection during exploration provide the best means toward reducing complications associated with traumatic duodenal injury.

A Clinical Study of Traumatic Duodenal Injury

PURPOSE: Traumatic duodenal injury is rare. There is no consensus on what type of repair should be performed for duodenal perforations with respect to their varying severity. As a result, surgeons are confronted with the dilemma of choosing between several diagnostic tests and many surgical procedures. In this study, we report our experience with treating traumatic duodenal injury and also offer a review of the literature. METHODS: Seventeen patients with duodenal injury following abdominal trauma were treated by several methods between January 1992 and October 2006. Based on review of the medical records, we classified the patients as having grade I through V duodenal injury using the scale constructed by the American Association for the Surgery of Trauma (AAST). We also noted clinical features, operative management, and outcome. RESULTS: Among 17 patients, one patient who had a duodenal intramural hematoma was treated by conservative management. Seven patients were treated by duodenojejunostomy, with only one complication. The remaining 9 patients underwent various operations, including primary closure alone (n=3), primary closure with jejunal patch (n=1), primary closure with duodenostomy (n=3), and pancreaticoduodenectomy (n=2). The complication rate among patients who underwent surgery within 24 hours after injury was 1 case among 13. However, complications occurred in all 4 surgical cases undertaken more than 24 hours after injury. CONCLUSION: Early diagnosis (within 24 hours) and thorough inspection during exploration provide the best means toward reducing complications associated with traumatic duodenal injury.

A Clinical and Hematological Analysis of the Traumatic Splenectomy

PURPOSE: The spleen is the organ most frequently injured by abdominal trauma; often by penetrating wounds to the left lower chest, flank and upper abdomen. A total splenectomy is considered the standard method of treating a splenic injury in the case of multiple organ injuries, a hemodynamically unstable condition and severe splenic injury. During the 5 years, between May 2001 and October 2005 55 splenectomy cases were performed at our clinic. This study was carried out to evaluate the clinical and hematological analysis of a splenectomy undertaken due to trauma (39 cases), with the exception of hematological diseases (16 cases). METHODS: We analyzed the clinical manifestations, intraabdominal blood loss, the total amount of transfusion, postoperative complications, and the distribution of platelet counts after a splenectomy, average time to reach maximal platelet counts and return normal platelet counts, and the periods of aspirin medication in 39 traumatic splenectomy cases. RESULTS: The male to female ratio was 2.3 : 1, with the most frequently injured age group being those in their third decade. The most common cause of injury was traffic accident (76.9%). There were 24 (61.5%) cases of associated injury, with the most frequents associated injury being a rib fracture (17 cases). The most common type of splenic injury was Type IV (59%). The average amount of intraabdominal blood loss and amount of transfused blood were 1,850 and 2,700 ml, respectively. The postoperative complication rate was 33.3% (13 cases), with pulmonary complications the most common (8 cases). Thrombocytosis occurred in 33 case 84.6%. After a splenectomy, the first increasing platelet count was noted after an average of 6.7+/-2.0 days, with the maximal count reached after an average of 10.8+/-2.8 days. The platelet count gradually returned to normal levels after an average of 36.1+/-20.0 days. Aspirin was medicated from a minimum of 9 to a maximum of 39 days, with an average of 23.3 days. CONCLUSION: Men in thier twenties were the most commonly injured group. Grade IV splenic injuries were the most common type requiring surgery. The average time to reach postoperative maximal platelet counts was 10.8 days. The patients where the platelet count increased above 750,000/ mm3 were treated with aspirin; there were no complications. Therefore, it is advisable to start patients on aspirin medication of aspirin, and follow up thier needs as out-patients with regular CBC workups.

Hematological Features of Coagulopathy and the Efficacy of Antivenin Therapy for a Korean Snakebite

PURPOSE: Snake venom induced coagulopathy is a major cause of both morbidity and mortality among affected patients. The effects of venomous factors to coagulation cascade and fibrinolysis were verified by analyzing the hematological data and clinical features of envenomed patients, and the efficacy of blood products transfusion and antivenin against a Korean snakebite clarified. METHODS: A retrospective study was conducted on 57 patients, admitted to the Department of Surgery of Chuncheon Sacred Hospital, between July 2002 and October 2005. According to the guidelines for assessing the severity of North American envenomination, the patients were divided into three groups according to severity, and the clinical course, DIC profile and usages of blood products and antivenin then analyzed. RESULTS: Of the 15 patients in the severe group (26.3%), 9 (60.0%) developed severe coagulation abnormalities, similar to DIC. No substantial bleeding or thrombic event manifested. All the patients with initial hypofibrinogenemia (33.3%) and unmeasured PT/aPTT during the 2nd to 4th hospital days (46.7%) progressed to severe coagulopathy. On average, these patients received transfusions of 18.4 +/- 6.1 pints of FFP and 14.4 +/- 14.9 pints of platelet product. The average amounts of antivenin applied were 1.2 +/- 0.4, 1.7 +/- 0.5 and 2.8 +/- 0.8 vials for the Minimal, Moderate and Severe groups, respectively. There was no death due to a Korean snakebite during this period. CONCLUSION: Korean snake venom is assumed to be a complex mixture of anticoagulant, platelet active and fibrinolytic venom. The discrepancy between abnormal coagulopathy and the clinical course explains venom induced DIC-like syndrome. Hypofibrinogenemia is the most reasonable predictor of DIC-like syndrome. Abrupt prolongation of PT/aPTT during the 2nd to 4th hospital days must weigh against thrombocytopenia. An early antivenin injection, along with the proper use of blood products, could improve the clinical course of envenomed patients.

The effect of Helicobacter pylori eradication on the improvement of the symptoms in patients with functional dyspepsia and peptic ulcer disease / 대한내과학회지

BACKGROUND: In the functional dyspepsia, Helicobacter pylori has been suggested as a causative agent. But, the effect of H. pylori eradication is still debated on functional dyspesia. The purpose of this study was to evaluate the effectiveness of the H. pylori eradication therapy in the improvement of the symptoms in patients with functional dyspepsia. METHODS: The convenience sample consisted of 123 patients with functional dyspepsia and 80 patients with peptic ulcer diseases who were infected with H. pylori. All patients had received eradication therapy of H. pylori for one or two weeks and additional therapy with H2RA or PPI for one to five weeks. After the treatment was completed, the patients were asked about their symptomatic improvement every three months. The degree of symptom was rated on a five-point Likert scale. RESULTS: Overall eradication rate of H. pylori was 82.8% (168/203), and there were no significant differences in the eradication rate between the two groups and between one-week and two-week eradication therapies. The mean follow-up period was 12 months. The symptomatic improvement in both group was maintained over 12 months in most patients (PUD 72.5% vs. FD 67.4%). In addition, the symptomatic improvement in the patients with eradication success was maintained significantly longer than those with eradication failure in both group (FD p=0.007 vs. PUD p=0.014). CONCLUSIONS: The eradication therapy of H. pylori can be one of the therapeutic options for patients with functional dyspepsia and that eradication failure may cause the recurrence of the symptom.

Iatrogenic or Traumatic Pseudoaneurysms of Peripheral Artery: 2 Cases Report

Pseudoaneurysm can occur as the result of penetrating trauma, infection and as the sequelae of radiologic intervention. Acupuncture is widely used in oriental countries such as China, Japan and Korea. In western countries acupuncture therapy is used to treat musculoskeletal symptoms such as sprain or strain. Some complications have been reported after acupuncture therapy. Vascular trauma after orthopedic surgery is relatively rare, but it is a significant complicaiton that increases the morbidity and mortality. We had experienced two different cases of pseudoaneurysms that occurred after acupuncture and orthopedic surgery respectively and the patients were treated successfully with interventional and surgical procedures.

Iatrogenic or Traumatic Pseudoaneurysms of Peripheral Artery: 2 Cases Report

Pseudoaneurysm can occur as the result of penetrating trauma, infection and as the sequelae of radiologic intervention. Acupuncture is widely used in oriental countries such as China, Japan and Korea. In western countries acupuncture therapy is used to treat musculoskeletal symptoms such as sprain or strain. Some complications have been reported after acupuncture therapy. Vascular trauma after orthopedic surgery is relatively rare, but it is a significant complicaiton that increases the morbidity and mortality. We had experienced two different cases of pseudoaneurysms that occurred after acupuncture and orthopedic surgery respectively and the patients were treated successfully with interventional and surgical procedures.

A Study of the core curriculum of family medicine residency Program in Korea

BACKGROUND: In order to provide basic data which are necessary for the standard reference of residency training program in family medicine, we analysed of family practice residency program in Korea(the core curriculum) which has 313 items - diseases and problems - proposed by the Korea Academy of Family Medicine. METHOD: Each items of the core curriculum of family practice residency program In Korea were sorted according to ICD-10. They were the mogt compared to common 100 diseases and clinical cases in family medicine department. of a tertiary hospital in one year. The most common 100 diseases were listed according to ICD-10, also. But some items which were difficult to sort were excluded. Eighty eight types of diseases were sorted.7inical data of a tertiary hospital included 9138 cases. RESULTS: Comparing to clinical cases of a tertiary hospital, the core curriculum includes 93.2% cases of family medicine department of a tertiary hospital. Among the 17 fields of the core curriculum, 12 fields were found in about 50% or more among cases of the clinic and 5 fields were in less than 50% Among 88 diseases, the core curriculum includes 78 diseases. 10 diseases were excluded. In the most common 100 diseases, 12 diseases were related to trauma and the core curriculum did not include them. CONCLUSION: Generally the core curriculum included highly prevalent diseases, but did not include some diseases which is important. Revision to make up for the weak points in the current core curriculum may be necessary.

Effect of Inslulin Administration on the Physical Performance of Rats and Mice

The correlation between muscle glycogen content and physical performance in mice was evaluated by investigating whether an increase in glycogen content in skeletal muscle with insulin administration can improve the physical performance without other effects of exercise. Albino rats(group I) were divided into two groups, i.e., insulin and saline administered group. The former experimental group was treated with protamine zinc insulin(15U/kg/day) subcutaneously for two weeks to increase the content of the muscle glycogen and the latter control group with saline. Mice (group II) were also divided into insulin treated and control groups and both groups were subjected to running exercise on an animal treadmill up to point of exhaustion once every day. After two weeks of insulin treatment, the muscle glycogen content, the maximal running time and the maximal swimming time were measured in non-exercised group I. In group II, after 12 days of insulin and saline administration, the muscle glycogen content, the maximal running time, concentrations of lactate and pyruvate in the blood were measured before and after the maximal exhaustive running. The results were summarized as follows. In group I, the muscle glycogen content, the maximal running time and the maximal swimming time of the insulin administered group were significantly greater of the control groups. In group II, the maximal running time was significantly greater(P < 0.01) in the experimental group than of the control group, while the muscle glycogen content revealed no significant difference between the two groups. On the other hand, lactate concentration and lactate/pyruvate ratios in the blood were significantly lower in the experimental group than those of the control groups. From the above results, it may be concluded that the elevation of muscle glycogen content alone by insulin treatment without any previous physical training can improve physical performance of rats. And insulin was also found to improve physical performance even in experimental animals which had been subjected to a longterm of exercise.