Ipsilateral fractures of the femoral neck and shaft represent many difficulties in diagnosis and treatment. The femoral neck fracture of this injury is commonly missed on initial evaluation. The overlooked femoral neck fracture may lead to higher risk of complications such as avascular necrosis of the femoral head, nonunion and coax vara. The authors reviewed nine cases of ipsilateral femoral neck and shaft fracture treated in our clinic from September 1989 to May 1995, and average follow-up period was 33 months(range, 12 to 101 months). The results obtained were as follows : 1. The most common cause of injury was traffic accident, and three femoral neck fractures were missed initially. 2. The most common site of femoral neck fractures was basicervical in 7 cases, and that of shaft fracture was middle 1/3 shaft in 5 cases. 3. The most common associated injury was ipsilateral knee injury(6 cases). 4. Five cases were treated with femoral reconstruction nail, two with multiple neck-pinning and retrograde interlocking IM nail, one with multiple screws for neck fracture and long dynamic compression plate for shaft fracture, and the other, multiple neck-pinning and antegrade interlocking IM nail. 5. The complications were a refracture of the shaft after removal of interlocking nail and a delayed union of shaft fracture which had been treated by reconstruction nailing. Coxa vara, delayed union and metal loosening were found in femoral neck fracture site, but all that were clinically acceptable. In conclusion, the fracture of femoral neck should be kept in mind not to be lost in case of high velocity-femoral shaft fracture, and if found, it should be treated with anatomical and rigid internal fixation in femoral neck fracture having first priority. Recently reconstruction nail for the treatment of these fractures was widely used, but that is technically difficult and might destroy the neck fracture during shaft fracture fixation. We recommend retrograde interlocking nail followed by multiple neckpinning might be safe and stable fixation for the ipsilateral neck and shaft fracture.
Accidents, Traffic ; Coxa Vara ; Diagnosis ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Fracture Fixation ; Head ; Knee ; Neck ; Necrosis

PURPOSE: This study examined Korean clinical nurses' intentions to care for SARS patients and identify determinants of the intentions. Theory of planned behavior was the framework to explain the intentions of Korean nurses for SARS patients care. METHODS: A convenient sample of six hundreds and seventy nine clinical nurses from four university-affiliated hospitals located in Seoul and in Kyung-gi province was used. Self-administered (83-items) questionnaire was used to collect data. Intentions, attitude, subjective norm, perceive behavioral control, behavioral beliefs, normative beliefs, and control beliefs were the study variables. All items were measured using 7-point Likert scale (-3 to +3). Data were analyzed using descriptive statistics, Pearson correlation method, and stepwise multiple regression methods. RESULTS: Intentions and attitudes toward SARS patient care among Korean clinical nurses were moderate, but their subjective norm and perceive behavioral control of SARS patients care were negative. Stepwise multiple regression analysis indicated that attitude toward SARS patient care, perceived behavioral control, subjective norm were the determinants of the intentions for SARS patients care as theory proposed. Among the behavioral beliefs, "SARS-patient caring would be a new experience", "during SARS-patient caring, I should be apart from my family", "after completing SARS-patient caring, I would be proud of myself being able to cope with a stressful event" and "with my SARS-patient caring, patients could recover from SARS" were the significant determinants. Among the normative beliefs, colleague approval, spouse approval, and physician approval were significant determinants of the intentions. Among the control beliefs, "SARS-patient caring would be a challenge" "SARS-patient caring is a professional responsibility", "tension during the care of SARS patients" and "support from team members" were the significant determinants of the intentions. CONCLUSIONS: Korean clinical nurses in this study were not willing to care for SARS patients and showed negative attitude toward the care. They believed their friends and family were not approved their care for SARS patients. Nurses were in conflicts between professional responsibilities to care for SARS patients and personal safety. This study was the first to understand stress and burden of Korean clinical nurses who are in front line to care for newly developed communicable disease such as SARS. Under the circumstance where several fatal communicable diseases are predictable, conflicts between professional responsibility and their personal risks should be taken into considerations by nurses themselves and by nursing administrators in order to improve quality of care.
Adult ; *Attitude of Health Personnel ; Female ; Humans ; *Intention ; Korea ; Middle Aged ; Multivariate Analysis ; Nursing Staff, Hospital/*psychology ; Psychological Theory ; Regression Analysis ; Severe Acute Respiratory Syndrome/*nursing

Lymphoma is a common cause of nontraumatic chylothorax. Clinical success rates of thoracic duct embolization are lower in patients with nontraumatic chylothorax compared to patients with traumatic chylothorax. Herein, we report a case of nontraumatic chylothorax and lymphoma in a 77-year-old man managed with thoracic duct embolization. The chest tube drainage decreased but not was sufficient to enable removal of the chest tube. Therefore, a second embolization was performed through a direct puncture of the lymphatic mass in the lung, following which the chyle leakage ceased, and the chest tube was removed. The treatment strategy discussed in this report may be an effective therapeutic option for select patients with nontraumatic chylothorax.

OBJECTIVES: Several lines of evidence suggest the serotonergic dysfunction involved in the biological susceptibility of suicide. Tryptophan hydroxylase (TPH), the rate-limiting enzyme in the biosynthesis of serotonin, plays a vital role in serotonin metabolism. In a case-control study, we investigated whether the TPH gene was a susceptible factor for suicidal behavior in depressive patients. METHODS: The subjects were 218 depressed patients who attempted suicide and visited emergency rooms in multi-medical centers. One hundred thirty hospitalized non-suicidal depressed patients and the 161 normal controls were matched with the suicidal group. Individuals in all 3 groups were evaluated independently by a Structured Clinical Interview for the purpose of establishing a DSM-IV criteria diagnosis (SCID). The severity of depressive symptoms was evaluated using Hamilton depression rating scale (HDRS). RESULTS: There was no significant difference in genotype distributions and allele frequencies of TPH intron 7 A218C polymorphisms among 3 groups. Furthermore, no significant difference in genotype counts and allele frequencies of the polymorphisms was found among lethal suicidal depressed patients, non-suicidal depressed patients and the normal controls. CONCLUSION: This study suggests that the A218C polymorphism of the TPH gene is unlikely to have a major effect on the susceptibility of suicidal behaviors in depressive patients.
Case-Control Studies ; Depression ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Emergencies ; Gene Frequency ; Genotype ; Humans ; Introns ; Serotonin ; Suicide ; Suicide, Attempted ; Tryptophan ; Tryptophan Hydroxylase

Left-sided gallbladder (LSGB) is a rare anomaly, but it is often associated with multiple combined variations of the liver anatomy. We present the case of a patient with LSGB who underwent successful resection of perihilar cholangiocarcinoma. The patient was a 67-year-old male who presented with upper abdominal pain and obstructive jaundice. Initial imaging studies led to the diagnosis of Bismuth-Corlette type IIIB perihilar cholangiocarcinoma. Due to the unique location of the gallbladder and combined multiple hepatic anomalies, LSGB was highly suspected. During surgery after hilar dissection, we recognized that the tumor was located at the imaginary hilar bile duct bifurcation, but its actual location was corresponding to the biliary confluence of the left median and lateral sections. The extent of resection included extended left lateral sectionectomy, caudate lobe resection, and bile duct resection. Since some of the umbilical portion of the portal vein was invaded, it was resected and repaired with a portal vein branch patch. Due to anatomical variation of the biliary system, only one right-sided duct was reconstructed. The patient recovered uneventfully without any complication. LSGB should be recognized as a constellation of multiple hepatic anomalies, and therefore, thorough investigations are necessary to enable the performance of safe hepatic and biliary resections.
Abdominal Pain ; Aged ; Bile Ducts* ; Biliary Tract ; Cholangiocarcinoma* ; Diagnosis ; Gallbladder* ; Hepatectomy* ; Humans ; Jaundice, Obstructive ; Liver ; Male ; Portal Vein

Intracaval neoplastic extension of renal cell carcinoma to the right atrium has been reported in 14-39% of the patients with carcinoma involving the vena cava. We report a case of 44-year-old woman hospitalized with intermittent vomiting and presented with evidence of renal cell carcinoma extending into the inferior vena cava and right atrium on CF and MRI. We successfully managed renal cell carcinoma surgically extending into the right atrium using hypothermia and circulatory arrest.
Adult ; Carcinoma, Renal Cell* ; Female ; Heart Atria* ; Humans ; Hypothermia* ; Magnetic Resonance Imaging ; Vena Cava, Inferior* ; Vomiting

BACKGROUND: As single donor platelets (SDP) has been increasingly used, the quality of SDP, especially apheresis-induced platelet activation, has become a major issue. This study evaluated the activation of SDP platelets prepared with three different cell separators that are currently being used at the Korean Red Cross. METHODS: CD62p, CD63 and CD42 were measured in 35 units of SDP prepared with Amicus (Baxter, Deerfield, IL, USA), MCS+ (Haemonetics, Braintree, MA, USA), or Trima (Gambro BCT, Lakewood, USA) using flow cytometry. RESULTS: Expression of CD62p gradually increased with storage time, but no difference in expression was noted between cell separators. Expression of CD63 also increased with storage time and platelets prepared with the Amicus displayed significantly higher CD63 expression 72 and 120 hours after collection compared to those prepared with MCS+ and Trima. Expression of CD42b tended to decrease with storage time, but this was only significant for Amicus 120 hours after collection. No difference in CD42b expression was noted between cell separators. CONCLUSIONS: Platelet activation increased with storage time, and platelet activation was more pronounced in the platelets prepared with the Amicus. However, because in vitro results of platelet activation does not necessarily reflect in vivo platelet function and survival, additional studies are needed to clarify clinical effectiveness of activated platelets.
Blood Platelets* ; Flow Cytometry ; Humans ; Platelet Activation* ; Plateletpheresis* ; Red Cross ; Tissue Donors

BACKGROUND: Portal triad clamping (PTC) during hepatic resection (Pringle maneuver, PM) can afford reduced intraoperative bleeding and bloodless surgical field. But inflow obstruction of blood to liver during PM can bring hemodynamic changes to the patient. This study was designed to evaluate the hemodynamic changes before, during and after PM application during hepatic resection. We also compared the hemodynamic effects of hepatic cooling before PM with/without portal decompression during PM. METHODS: The patients were divided into three groups; PM (P group, n=9), PM after hepatic cooling with 400 ml of 4oC lactated Ringer's solution (LR) (C+P group, n=13), PM after hepatic cooling and portal decompression with portocaval shunt (C+P+S group, n=7). Systemic vascular resistance index (SVRI), cardiac index (CI) and mean arterial pressure (MAP) were measured before, during and after PM. RESULTS: Portal pressure of C+P+S group (208.3+/-36.6 mmH2O) was lower than P (487.3+/-92.9 mmH2O) and C P (553.6+/-77.0 mmH2O) group during PM. CIs of P and C P group were decreased (15, 13% respectively) during PM. After reperfusion, CIs and SVRIs of P, C+P and C+P+S group were all increased (CI; 33, 26, 50%, SVRI; 30, 40, 50%, respectively) than end of PM. CONCLUSION: PM itself doesn't make abrupt hemodynamic change. Hepatic cooling with 4oC LR (400 ml) before PM increases MAP because of increased SVRI. Reperfusion after PM for 50 minutes, hemodynamic depression could occur by decreased SVRI, especially in case of decompressed portal pressure with portocaval shunt during PM.
Arterial Pressure ; Constriction* ; Decompression* ; Depression ; Hemodynamics* ; Hemorrhage ; Humans ; Liver ; Portal Pressure ; Reperfusion ; Vascular Resistance

BACKGROUND: Portal triad clamping (PTC) during hepatic resection (Pringle maneuver, PM) can afford reduced intraoperative bleeding and bloodless surgical field. But inflow obstruction of blood to liver during PM can bring hemodynamic changes to the patient. This study was designed to evaluate the hemodynamic changes before, during and after PM application during hepatic resection. We also compared the hemodynamic effects of hepatic cooling before PM with/without portal decompression during PM. METHODS: The patients were divided into three groups; PM (P group, n=9), PM after hepatic cooling with 400 ml of 4oC lactated Ringer's solution (LR) (C+P group, n=13), PM after hepatic cooling and portal decompression with portocaval shunt (C+P+S group, n=7). Systemic vascular resistance index (SVRI), cardiac index (CI) and mean arterial pressure (MAP) were measured before, during and after PM. RESULTS: Portal pressure of C+P+S group (208.3+/-36.6 mmH2O) was lower than P (487.3+/-92.9 mmH2O) and C P (553.6+/-77.0 mmH2O) group during PM. CIs of P and C P group were decreased (15, 13% respectively) during PM. After reperfusion, CIs and SVRIs of P, C+P and C+P+S group were all increased (CI; 33, 26, 50%, SVRI; 30, 40, 50%, respectively) than end of PM. CONCLUSION: PM itself doesn't make abrupt hemodynamic change. Hepatic cooling with 4oC LR (400 ml) before PM increases MAP because of increased SVRI. Reperfusion after PM for 50 minutes, hemodynamic depression could occur by decreased SVRI, especially in case of decompressed portal pressure with portocaval shunt during PM.
Arterial Pressure ; Constriction* ; Decompression* ; Depression ; Hemodynamics* ; Hemorrhage ; Humans ; Liver ; Portal Pressure ; Reperfusion ; Vascular Resistance

No abstract available.
Catheters* ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Fetal Therapies* ; Lung*