Limited Motion of Arms in Uncommunicable Children

PURPOSE: The study was designed to identify the necessity of radiographs and to decrease overutilization of radiographs in uncommunicable children who do not move their arms. This study provides clinical guidelines on radiographic evaluation and treatment of children with limited motion in the upper extremity. METHODS: The cases of one hundred thirteen pediatric patients under 36 months of age, who had visited the Emergency Center of Korea University Ansan Hospital from January 2000 to December 2001, were retrospectively reviewed. Pediatric patients with upper extremity injuries due to multiple trauma, laceration or motor vehicle accident were excluded. Parameters analyzed were age, sex, mechanism of injury, physical findings, radiographic finding, and injuried upper extremity region. We described focal tenderness and regional edema as physical finding. Each patient without regional edema was classified into an improved or a not-improved group depending on the outcomes after manual reduction. All statistical tests were conducted with twotailed levels of 0.05. RESULTS: Of the 113 patients, the mean age was 18.6+/-0.89 months. The most common injury mechanisms were unknown and traction. Minimal edema in the elbow joint was seen in 5 cases, and supracondylar fractures due to short falls were seen in 4 (80%) of those cases (p<0.05). The improved group was finally confined to radial head subluxation in 88 patients. Although all the not-improved-group patients had received radiographs, no abnormal findings were seen in the elbow. However, clavicle fracture due to fall above or from a level surface were seen in 4 cases (20%) of the not-improved group (p<0.05). No difference of injury mechanism existed between the improved and the not-improved groups. CONCLUSION: Recommand Radiographic evaluations in Children not-used arm with regional edema before manual reduction. But without regional edema, manual reduction of elbow is first. If children without regional edema do not improve after manual reduction of elbow and they are injuried due to fall, children should be assessed for fractures of clavicle.

Lack of IL-10 Release from Human Polymorphonuclear Leukocytes

PURPOSE: Polymorphonuclear leukocytes (PMNs) are the first line of cellular response for host defense during acute inflammation. The ability of PMNs to produce and release numerous pro-inflammatory cytokines is now estabilished and plays an important role in triggering and maintaining the inflammatory response. We studied the autocrine downregulation of this process by invesgating the potential production by human PMNs of the major anti-inflammatory cytokine, interleukine 10 (IL-10). METHODS: Human PMNs were isolated from the peripheral blood of health volunteers by using the modified boyum method. Human PMNs were incubated at 37 degrees Cwith and without formyl Met-Leu-Phe (fMLP) for 30 minute, 2 hours, 4 hours, and 20 hours. The level of IL-10 was determined in each of the cell-free supernatants by using the enzyme linked immunosorbent assay (ELISA) method. RESULTS: Non-stimulated PMNs generated 1.40 +/- 1.791pg/mL to 3.46 +/- 1.607 pg/mL of IL-10 over the time course. Stimulation with fMLP resulted in an increase in the constitutive PMN-derived IL-10 by 2.74 +/- 0.762 pg/mL, 1.27 +/- 0.262 pg/mL, 1.19 +/- 0.364 pg/mL, and 2.44 +/- 1.317 pg/mL at 30 min, 2 hr, 4 hr, and 20 hr after stimulation, respectively, but these increases were not statiscally significant. CONCLUSION: Human PMNs seem unable to induce release of the most potent anti-inflammatory cytokine, IL-10, and down-regulate inflammatory response due to the autocrine mechanism. This could partly account for the persistence of local inflammation, when PMNs are the main infiltrating cells.

Anti-inflammatory effects of IL-4 and IL-10 on Human Polymorphonuclear Leukocytes

Inflammatory responses are strictly regulated by coordination of pro-inflammatory and anti-inflammatory mediators. Interleukin-4 (IL-4) and interleukin-10 (IL-10) have typically the biologic anti-inflammatory effects on monocytes, but uncertain effects on polymorphonuclear leukocytes (PMNs). The PMNs are the first line of cellular response for host defense during acute inflammation. To modify hyper-inflammatory reaction with biologic anti-inflammatory mediators, we have determined the biologic anti-inflammatory activities of IL-4 and IL-10 on human PMNs. Human PMNs were pretreated with IL-4 or IL-10 and then stimulated with formyl methionyl leucyl phenylalanine (fMLP) for times indicated. The level of H2O2, interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) were determined in the each cell free supernatants. fMLP plays the role of a typical pro-inflammatory agent and, at least in determined conditions, down-regulated TNF release. IL-4 acts as an anti-inflammatory mediator but IL-10 did not show its anti-inflammatory activities on fMLP-stimulated human PMNs. IL-4 and IL-10 have different anti-inflammatory mechanisms. Perhaps, IL-10 needs co-factors to act as an anti-inflammatory mediator.

Prognostic Factors of Geriatric Trauma Patients

BACKGROUND: It has been documented that certain prognostic factors may affect the outcomes of the old aged victims by trauma. Considering that trauma is the sixth most common cause of death in people over the age of 65 years and there is a rapid growth of elderly population, it is paramount to understand the prognostic factors when dealing with geriatric trauma patients. Hypothesis and Goals : It can be hypothesized that the prognostic factors should be determined independently between populations being consisted of different races, countries, socio-economic states, cultures, or so on. Thus, study was designed to evaluate the factors affecting the outcomes of elderly Korean trauma patients. METHODS: One hundred forty six patients aged over 65 years were retrospectively reviewed, who visited the Emergency Canter of Korea University from January, 1997 to June, 1998. Of 146 patients, 7 were excluded due to discharge against advice or transfer to the other hospitals. Parameters analysed were age, sex, mechanism of injuries, body region injured, Injury Severity Score (ISS), previous medical illness, hospital morbidity, duration of hospital stay, and cost. Each patient was classified into improved or not-improved groups depending on the outcomes, and young-old or old-old group depending on the age. The factors affecting the hospital stay in improved patients were analyzed in the parameters of previous medical illness, hospital morbidity, multiple injuries, ISS, and age. All statistical tests were conducted with two-tailed levels of 0.05. RESULTS: Of 139 patients, the mean age was 74+/-7.1 years, mean ISS 9.3+/-7.26, mean hospital stay 27+/-27.1 days. Most commonly injured body region was the extremities due to fall from a level surface. Rate of previous illness showed 0.94 medical diseases per person and were aggravated after trauma in 39 patients (60.9%). Hospital morbidity rate was 0.46 incidents per person. There were no differences in age and duration of hospital stay between the improved and the not-improved group. Substantial differences were noted in affected body region, incidence of previous illness, and hospital morbidity between the groups (p=NS). Not-improved group had higher ISS (p<0.05). ISS, previous illness and hospital morbidity affected the duration of hospital stay in the improved group. Hospital stay was 40+/-25.1 days in patients with ISS over 6 while 6+/-8.6 days in those with ISS 5 (p<0.05). Hospital stay in the improved was 26+/-26.9 days while 31+/- 24.8 days in the improved old-old group (P=NS). Hospital stay in the young-old minor trauma (ISS5) patients with previous illness and hospital morbidity was 26+/-10.1 days while 4+/-7.3 days in those without previous illness and hospital morbidity (p<0.05). CONCLUSION: Previous medical illness and hospital morbidity, not age, are predictive of outcomes of geriatric trauma patients with respect to hospital stay. As most of the hospital morbidity was a trauma-induced aggravation of previous medical illness and hospital morbidity contributing poor outcomes can be potentially avoidable, routine aggressive care far the geriatric trauma patients with previous medical illnesses is needed.