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A carotid-cavernous fistula (CCF) is a pathologic arteriovenous communication between the carotid artery and the cavernous sinus, and the incidence of CCF as a result of craniofacial trauma is less than 0.2%. Traumatic internal carotid artery dissection (TICAD) is a rare phenomenon, occurring in 0.02 to 0.67% of cervical blunt trauma cases. We report a rare case of CCF associated with ICAD after craniofacial trauma injury, which is very rare. A 23-year-old woman presented with left ptosis on 21 days after a car crash accident. She had suffered from headaches, diplopia, tinnitus, and dizziness. Brain MRI revealed no mass or aneurysmal sac or intracranial hemorrhage, but cerebral angiography showed CCF with ICAD. She was treated with a ICAD percutaneous transarterial stent and endovascular embolization, 1 months after cerebral angiography. clinicians treating patients with craniofacial injuries should have a complete understanding of these patients` entity, because urgent intervention may improve outcome.
Purpose: This study analyzed the value of 9 9 mTc - MIBI SPECT (Single Photon Emission Computed Tomography) in the diagnosis of myocardial contusion after blunt chest trauma . Methods: We evaluated 24 patients with cardiac contusions after blunt chest trauma who were diagnosed by clinical symptoms, chest x-ray, electrocardiogram(ECG), and Creatine phospho-kinase(CPK). 9 9 m Tc-MIBI SPECT was performed within 48 hours along with the above tests prospectively . Results: 1. Among the 24 patients, 14 patients were finally diagnosed as having a myocardial contusion by means of ECG, echocardiography, 9 9 mTc-MIBI SPECT, and cardiac enzyme. 2. The sensitivity, specificity and accuracy of 9 9 mT c -MIBI SPECT were 46.7%, 66.7%, and 54.2%, respectively. The same results for initial ECG were 46.6%, 88.9%, and 62.5%. 3. For those who had positive findings in 9 9 mTc - MIBI SPECT, average hospital stay was 14.5 days and abnormal electrocardiogram was found in 90.0%. However, for those who had negative findings, average hospital stay was 11.2 days and abnormal electrocardiogram was found in 35.7%. Conclusion: 99 mTc-MIBI SPECT is not a definite modality in diagnosing myocardial contusion, but can be useful in diagnosing and determining the need for hospitalization after cardiac contusion.
This paper investigated an optimal belt path for minimizing maximum chest deflection of THOR-M50 dummy. To understand structural characteristics of the thorax region, a series of thorax compression tests were performed. Based on the test results, an optimal belt path, which path through the mid-point of the upper IR-TRACC was suggested. The optimal belt path, then, was verified through belt pull tests. Since the belt pull experiment was performed under a simplified static condition, the validity of the optimum belt path need to be verified under dynamic loading conditions such as sled or vehicle crash tests.
김용인 ( Yong In Kim ), 노기철 ( Ki Cheul Noh ), 강영준 ( Young Joon Kang ), 임용수 ( Yong Su Lim ), 양혁준 ( Hyuk Jun Yang ), 이근 ( Gun Lee ), 진욱 ( Wook Jin ), 황성연 ( Seong Youn Hwang ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2
Background: Simple cervical X-rays often miss cervical spine injuries. Magnetic resonance imaging is valuable in these cases. The aims of this study is to determine high-risk factors of the cervical injuries, and to contribute to make indications of cervical MRI in evaluation of blunt trauma patients. Methods: We retrospectively reviewed the patients who visited our ED due to nuchal pain and examed by simple cervical X-ray and cervical MRI after blunt trauma. We analyzed the incidence of abnormal MRI findings in various patients groups. We also compared the incidence of missed cervical spine injury by level of injured spine. We thought cervical MRI to be goldstandard of this analysis. Results: The incidence of abnormality on cervical MRI is higher in male patients than female patients (p<0.01). Old (age≥40) patients frequently shows abnormal cervical MRI findings than young patients (p<0.001). In patients who had neurologic abnormality, the incidence of abnormality on cervical MRI is higher than neurologically normal patients (p<0.001). But, mechanisms of injuries and associated injuries are not related to the incidence of abnormality on cervical MRI. Injuries of lower cervical spine (C7) are frequently missed than those of other cervical spines (p<0.01). Conclusion: When evaluate cervical injuries in male, old, and neurologically abnormal patients, we must consider cervical MRI although the simple cervical X-ray is normal. We must pay more attention to lower cervical spine injuries than other cervical spine injuries.
Background: Recently, the number of patients with the thorax or neck trauma has increased due to traffic accidents, industrial disasters, incidental accidents, and violence. Most of the thorax or neck injuries can be managed with conservative methods and simple surgical procedures, but an open thoracotomy or exploration will be necessary in emergent cases. Traumas to the thorax and the neck have an extremely poor prognosis when not diagnosed and treated early. Therefore, we analyzed the results of emergent operations in patients with thorax or neck trauma and their clinical courses. Methods: A clinical evaluation was performed on 56 patients treated with emergent operations for thorax or neck trauma from January 1997 to July 2003 according to their medical Results: There were 45 males and 11 females. The mean age was 36.1 years. The modes of injury were as follows: traffic accidents 14 cases, stab wounds 27 cases, industrial disasters 7 cases, and others 8 cases. The annual distribution of cases was as follows: 1997 year 9 cases, 1998 year 6 cases, 1999 year 7 cases, 2000 year 10 cases, 2001 10 cases, 2002 6 cases and 2003 8 cases. The injured organs were 13 cases of a ruptured diaphragm, 12 cases of a ruptured lung, 7 cases of a ruptured heart, 2 case of a ruptured aorta, 9 cases of a simple vessel ruptured and 4 cases of a ruptured esophagus and trachea. There were 9 (16%) overall deaths: 6 cases in deaths among the blunt-trauma cases and 3 deaths among the stab injury cases. Conclusion: Early diagnosis and surgical treatment is essential for thorax or neck trauma, to decrease the mortality and complications. Therefore, careful diagnostic procedure, appropriate preoperative management for hypovolemia, and early surgical treatment are essential. The setup an of emergency operation system should be considered as a reform measure.