The arthroscopic rotator cuff repair is now considered a mainstream technique with highly satisfactory clinical results. However, concerns remain regarding healing failures for large and massive tears and high revision rate. In recent decades, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. The focus of biomechanical test in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. Recent studies have shown that a transosseous tunnel technique provides improved contact area and pressure between rotator cuff tendon and insertion footprint, and the technique of using double rows of suture anchors to recreate the native footprint attachment has been recently described. The transosseous equivalent suture bridge technique has the highest contact pressure and fixation force. In this review, the biomechanical tests about repair techniques of rotator cuff tear will be reviewed and discussed.
Rehabilitation ; Rotator Cuff* ; Suture Anchors ; Sutures ; Tears* ; Tendons

The clinical study on recurrent dislocation of the shoulder was performed on fourteen cases who were treated by Putti-Platt operation from July 1967 to November 1968. The cases studied were treated at the 17th Army Hospital in Kwang-ju and U.S. 121st Evacuation Hospital in Bu-pyung. Ages in initial dislocation were varied from 11 to 25 with an average of 18 years. Five cases of them were recurred over ten times prior to operation. On radiological findings, Hill-Sachs lesion has been revelaed in 57.1%. On pathological finding, Bankart lesion was seen in 78.5% and detachment of the glenoid labrum with capsular separation in 28.6%. No recurrence has been encountered in this s ries, and average rarige of abduction was gained upto 165 and external rotation 30°.
Clinical Study ; Dislocations ; Gwangju ; Hospitals, Military ; Recurrence ; Shoulder

BACKGROUND: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. METHODS: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. RESULTS: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). CONCLUSIONS: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
Advance Directives ; Cardiopulmonary Resuscitation ; Consent Forms ; Critical Illness* ; Hospital Mortality ; Humans ; Intensive Care Units ; Resuscitation Orders* ; Retrospective Studies ; Shock, Septic

PURPOSE: Following the first in 1990, the use of course evaluations(CE) by medical schools across the Republic of Korea has grown steadily since 1997. The purpose of this study was to investigate these CE programs and to make general recommendations for further implementation. METHODS: A questionnaire survey was conducted by mail. From June 20 to September 22, 2006, data was obtained from 38 of the 41(93%) medical schools in the country. Of those who responded, 27 schools also sent their CE forms as requested. RESULTS: There was little difference among the 38 medical schools in the main body, methods, frequency, grades, systems of evaluation, and types of survey. Evaluation criteria such as instructor effectiveness, course management efficiency, and student satisfaction showed high frequency, whereas issues concerning learning objectives and workload were less common. In contrast, the stated purposes of employing CE varied from school to school. While 92% of the respondents regarded improvement to the quality of instruction as the goal of their programs, 32% indicated that CE results also factored in administrative decisions concerning promotion, tenure, and salary increases. CONCLUSION: In addition to embracing the expanding role and influence of CE in Korean medical education, schools must proactively enact measures to enhance further implementation. First, evaluation criteria should be better formulated to increase the consistency, reliability, and validity of CE results. Next, to promote efficiency, the scheduling and methodology of CE administration should carefully consider the medical curriculum. Finally, professional attitudes should be fostered to recognize the value of CE as a tool for raising educational standards overall.
Curriculum ; Surveys and Questionnaires ; Education, Medical ; Humans ; Learning ; Postal Service ; Republic of Korea ; Salaries and Fringe Benefits ; Schools, Medical*

A cardiovascular collapse, due to preoperatively administered intravenous vitamin K (phytonadione), was experienced in a 59-year-old woman who was scheduled to undergo a left upper lung lobectomy. The patient developed sudden facial flushing, an upper torso rash, dyspnea, palpitation, and severe hypotension about 2 min after the intravenous administration of approximately 2 mg of vitamin K. Immediate hydration and an injection of 20 mg ephedrine restored her blood pressure to the preoperative level within 5 min. The patient recovered without any sequelae, but the operation was postponed. The patient's symptoms seemed to be due to an anaphylactoid reaction or anaphylaxis following the intravenous administration of vitamin K. This case report suggests that physicians should carefully review the indications of vitamin K prior to administration, even at low doses.
Administration, Intravenous ; Anaphylaxis ; Blood Pressure ; Dyspnea ; Ephedrine ; Exanthema ; Female ; Flushing ; Humans ; Hypotension ; Lung ; Middle Aged ; Torso ; Vitamin K ; Vitamins*

PURPOSE: Most students choose the same option to questions in course evaluation surveys. Identical answers to each question render the results unreliable. The purpose of this study was to analyze the trend of medical student' consistent responses to course evaluations. METHODS: The data of this study were the results of a course evaluation over 3 years (from 2006 to 2008) at the School of Medicine at A University. RESULTS: The proportion of students who replied with the same answers to each question was below 20%. This result was consistent in freshmen, sophomores, and junior students. Using a 5-point Likert scale, more than 40% of the students gave 5 points consistently. CONCLUSION: We conclude that student' responses to evaluations do not have a significant impact on the reliability of course evaluations at Medical School at A University. These results differ significantly from those of previous research. Hence, future studies are required to analyze course evaluations in medical schools using diverse aspects.
Humans ; Schools, Medical

The endophthalmitis is an ophthalmic emergency and it usually takes a tragic course, so its early diagnosis and appropriate treatment are urgently mandatory to preserve the vision and the eyeball. The authors found metastatic endophthalmitis developed during the course of acute pyelonephritis of two diabetic patients. In spite of aggressive topical and systemic managements, the disesed eyes were brought about to enucleation. The pathogens were proved to be Escherichia coli by culture of the specimen obtained from the vitreous. In accordance with cases and book review, it is emphasized that early recognition and aggressive treatments are essential in prevention of phthisis and blindness.
Blindness ; Early Diagnosis ; Emergencies ; Endophthalmitis* ; Escherichia coli ; Humans ; Pyelonephritis

The endophthalmitis is an ophthalmic emergency and it usually takes a tragic course, so its early diagnosis and appropriate treatment are urgently mandatory to preserve the vision and the eyeball. The authors found metastatic endophthalmitis developed during the course of acute pyelonephritis of two diabetic patients. In spite of aggressive topical and systemic managements, the disesed eyes were brought about to enucleation. The pathogens were proved to be Escherichia coli by culture of the specimen obtained from the vitreous. In accordance with cases and book review, it is emphasized that early recognition and aggressive treatments are essential in prevention of phthisis and blindness.
Blindness ; Early Diagnosis ; Emergencies ; Endophthalmitis* ; Escherichia coli ; Humans ; Pyelonephritis

BACKGROUND: Superior migration of humeral head has been conventionally determined by measuring the acromiohumeral distance (AHD), We sought to devise a novel measurement system more reliably and accurately than AHD. We described a structural landmark called 'C-line'. In this study, we investigated the clinical usefulness of 'step-off of the C-line (SOC)' compared to that of AHD. METHODS: The C-line formed from the medial margin of the proximal humeral head continuing up to the inferior margin of the articular glenoid and then to the lateral border of the scapula. The superior migration of the humeral head triggered by a rotator cuff tear introduces a discontinuity in this C-line. We measured the distance of this discontinuity. We enrolled 144 patients who underwent a rotator cuff repair. We selected 58 controls who didn't have any cuff lesions apparent on magnetic resonance imaging. Using radiographs derived from standardized true anteroposterior views of the shoulder, we measured the SOC and the AHD. We used t-tests for statistical analyses. RESULTS: A rotator cuff tear was associated with an increase in SOC and a decrease in AHD. In control group, the mean SOC was 1.29 ± 1.71 mm and AHD was 9.71 ± 2.65 mm. In cuff tear group, the mean SOC was 3.15 ± 3.41 mm and AHD was 8.28 ± 1.76 mm. The mean SOCs of the patient group in relation to the mean SOC of the control group according to tear size, the SOCs of medium tear and lager groups showed statistically significant increase (p<0.05). CONCLUSIONS: The SOC may be a similarly effective to diagnose cuff tears of medium size and larger compared with AHD.
Humans ; Humeral Head* ; Magnetic Resonance Imaging ; Methods* ; Rotator Cuff ; Scapula ; Shoulder ; Tears

Severe sepsis and septic shock are the main causes of death in critically ill patients. Early detection and appropriate treatment according to guidelines are crucial for achieving favorable outcomes. Endotoxin is considered to be a main element in the pathogenic induction of gram-negative bacterial sepsis. Polymyxin B hemoperfusion can remove endotoxin and is reported to improve clinical outcomes in patients with intra-abdominal septic shock, but its clinical efficacy for pneumonic septic shock remains unclear. Here, we report a case of a 51-year-old man with pneumonic septic shock caused by Pseudomonas aeruginosa, who recovered through polymyxin B hemoperfusion.
Cause of Death ; Critical Illness ; Gram-Negative Bacteria* ; Hemoperfusion* ; Humans ; Middle Aged ; Polymyxin B* ; Polymyxins* ; Pseudomonas aeruginosa ; Sepsis ; Shock, Septic*