Left External Iliac and Common Femoral Artery Occlusion Following Blunt Abdominal Trauma without Associated Bone Injury.

Blunt abdominal trauma may cause peripheral vascular injuries. However, blunt abdominal trauma rarely results in injuries to the external iliac and common femoral arteries, which often stem from regional bone fractures. Here, we present the case of a patient who had experienced trauma in the lower abdominal and groin area three months before presenting to the hospital, but these injuries did not involve bone fractures and had been managed conservatively. The patient came to the hospital because of left lower leg claudication that gradually became severe. Computed tomography angiography confirmed total occlusion of the external iliac and common femoral arteries. The patient underwent femorofemoral bypass grafting and was discharged uneventfully.

Epidemiology of trauma patients and analysis of 268 mortality cases: trends of a single center in Korea.

PURPOSE: There is an increasing incidence of mortality among trauma patients; therefore, it is important to analyze the trauma epidemiology in order to prevent trauma death. The authors reviewed the trauma epidemiology retrospectively at a regional emergency center of Korea and evaluated the main factors that led to trauma-related deaths. MATERIALS AND METHODS: A total of 17007 trauma patients were registered to the trauma registry of the regional emergency center at Wonju Severance Christian Hospital in Korea from January 2010 to December 2012. RESULTS: The mean age of patients was 35.2 years old. The most frequent trauma mechanism was blunt injury (90.8%), as well as slip-and-fall down injury, motor vehicle accidents, and others. Aside from 142 early trauma deaths, a total of 4673 patients were admitted for further treatment. The most common major trauma sites of admitted patients were on the extremities (38.4%), followed by craniocerebral, abdominopelvis, and thorax. With deaths of 126 patients during in-hospital treatment, the overall mortality (142 early and 126 late deaths) was 5.6% for admitted patients. Ages ≥55, injury severity score ≥16, major craniocerebral injury, cardiopulmonary resuscitation at arrival, probability of survival <25% calculated from the trauma and injury severity score were independent predictors of trauma mortality in multivariate analysis. CONCLUSION: The epidemiology of the trauma patients studied was found to be mainly blunt trauma. This finding is similar to previous papers in terms of demographics and mechanism. Trauma patients who have risk factors of mortality require careful management in order to prevent trauma-related deaths.

Placental transmogrification of the lung.

Placental transmogrification is a very rare lung disease, where the alveoli resemble the chorionic villi of placenta, and this change is a characteristic finding. A 31-year-old female patient presented with cough and dyspnea that had begun 2 weeks prior to admission. Along with giant bulla found in the left upper lung field, subsegmental consolidation was also identified in the lingular segment on plain chest radiograph and CT scan. Wedge resection was performed to remove the bulla. Pathologic examination of the resected bulla revealed destruction of the normal structures and characteristic villous and papillary changes. These changes led to a diagnosis of placental transmogrification. We made an encounter of an unusual placental transmogrification which had different image findings from other reported transmogrification cases. Thus, we report an atypical placental transmogrification case where both consolidation and giant bulla coexist.

New classification and clinical characteristics of reexpansion pulmonary edema after treatment of spontaneous pneumothorax.

OBJECTIVE: Reexpansion pulmonary edema (REPE) is a rare yet sometimes fatal complication associated with the treatment of lung diseases such as pleural effusion, pneumothorax, and hemothorax. The current study summarizes our experience with REPE for a 3-year period. METHODS: We prospectively collected demographic and clinical data on consecutive patients presenting to an academic university-based emergency department with spontaneous pneumothorax that was treated with closed thoracostomy for a 3-year period. RESULTS: Eighty-four study patients were enrolled between December 2002 and September 2005. Reexpansion pulmonary edema developed in 25 of 84 (29.8% [95% confidence interval, 21.0-40.2]) patients. Many cases of REPE were small and asymptomatic and only diagnosed on computed tomography of the chest. There was only one death (1.2% [95% confidence interval, A to B]). Reexpansion pulmonary edema was associated with patients with larger pneumothoraces without fibrotic changes and with patients with hypoxia and fibrotic changes. Classic REPE as seen on chest radiograph was 16 (19.0%) in 84 patients. Diffuse REPE as seen only on computed tomography and involved more than 1 lobe was 1 (1.2%) in 84 patients. Isolated REPE as seen only on computed tomography and limited to lesser than 1 lobe was 8 (9.5%) in 84 patients. CONCLUSIONS: The rate of REPE after tube thoracostomy of spontaneous pneumothorax is greater than previously reported and often asymptomatic. The risk of developing REPE is greater with larger pneumothorax, especially in patients without fibrotic lung changes, and with hypoxia in patients with fibrotic changes.

Inequalities in nonfatal work injury: the significance of race, human capital, and occupations.

Little research is conducted to examine the determinants of nonfatal injury on the job. In particular, this study stresses the importance of race, human capital, and occupational conditions in explaining nonfatal injury at work. It measures nonfatal work injury as an episode of work injury, using the data from the 1988 Occupational Health Supplement (1988 OHS) to the National Health Interview Survey (NHIS). First, this study confirms no association between race and nonfatal injury at work. Second, the findings show that human capital, expressed through education and work experience, is the crucial determinant of nonfatal injury at work. In general, workers of more years of schooling and more work experience encounter less nonfatal injury at work than their counterparts. Third, the results also demonstrate the significance of occupational conditions (occupational positions and work activity) for nonfatal injury at work. Specifically, workers in professional occupations experience less work injury than workers in production occupations, but more work injury than workers engaged in clerical jobs. Even after controlling for occupational positions, there is a significant correlation between work activity and nonfatal work injury. Our study is a first step towards the causation of nonfatal injury on the job in terms of race, human capital, and occupational conditions. Therefore, the next step of work injury study needs to consider the influence of the other important determinants on nonfatal injury at work.