The ankle joint plays important biomechanical role in erect position or ambulation. The ankle injury includes bony structures with articular surface, ligaments and soft tissue injury. So the goal of treatment is anatomical reduction of ankle mortise. Fifty two patients of ankle fractures which were admitted and treated in Seoul Adventist Hospital from January, 1980 to December, 1984, were analysed in the clinical and radiological aspect. The results obtained from this study were as follows; l. Of the 52 cases, male was 39 cases(75.0%) and female was 13 cases(25.0%). The average age of the patients was 33 years with range from 18 years to 75 years. 2. The most common cause of injury was traffic accidident. Nexts were fall down, sports injury, slip down and industrial injury in orders. 3. The most common type of the ankle fractures, according to the classification of Lauge-Hansen, was supination-external rotation type(40.4%). 4. 36 cases(69.2%) were treated with open reduction and internal fixation and 16 cases(30.8%) were treated with closed reduction. Poor outcome seemed closely related to the severity of the injury and degree of fracture displacement. 5. Accurate reduction and rigid internal fixation of the lateral malleolus without shortening was important factor. Classification of Lauge-Hansen was useful in the diagnosis and treatment of the ankle fractures.
Ankle Fractures ; Ankle Injuries ; Ankle Joint ; Ankle ; Athletic Injuries ; Classification ; Clinical Study ; Diagnosis ; Female ; Humans ; Ligaments ; Male ; Seoul ; Soft Tissue Injuries ; Walking

Hoke traction and immediate immobilization in a spica cast were used to treat 32 children ranging on age from two to eight year old who had closed femoral shaft fractures and no associated injuries. These 32 children admitted at the Seoul Advantist Hospital during period from Jan. 1977 to Dec. 1982 and follow up study was made for 1 to 4 years after fractures. End results obtained are as follows: 1. There was no clinical deformity at the fracture site after complete remodeling. 2. There was no disparity of the leg length greater than 12mm. 3. There was no residual angulation greater than 10° degree. As compared with results treated by Russel traction, this method provides improved length control, comparable control of angular and rotational alignment and considerable shortened hospital stay. It is our opinion that Hoke traction is a simple, safe, certain, comparable and economical method of treatment of femoral shaft fractures in young children.
Child ; Congenital Abnormalities ; Femur ; Follow-Up Studies ; Humans ; Immobilization ; Leg ; Length of Stay ; Methods ; Seoul ; Traction

BACKGROUNDS: Though K-ADL was developed and validated, weighting each item of K-ADL is needed to evaluate the severity of functional disability as a whole. METHODS: Nominal group technique was used to weight individual items of K-ADL. Relevant experts were recruited; one specialist in geriatrics, one expert in elderly health service, one doctor expert in questionnarie, one nurse and two social welfare workers and one caregiver who work in nursing home for elderly, one nurse working at dementia care center. At the first round, each expert assigned the weights of each item. At the second round, those experts met, discussed, and re-evaluated each weighting. Using the newly developed weighted score, we measured its validity compared to brain-disability grade and three experts' decision of severe dysfunction. RESULTS: For inability to perform task, 7 points were given to 'dressing'and 'washing face', 6 points to 'bathing', 9 points to 'feeding', 8 points to 'transfer and toileting'. If any assistance is needed, 7 points were scored to 'dressing', 4 points were scored to 'washing face', 'feeding', 'transfer' and 'toileting', 2 points were scored to 'dressing'. Correlation coefficient between weighted K-ADL sum and brain-disability grade was -0.665(p=0.000). CONCLUSIONS: We assigned differential weighting to each of K-ADL and found that summing weighted K-ADL was excellent in some validity test.
Aged ; Caregivers ; Dementia ; Geriatrics ; Health Services ; Humans ; Nursing Homes ; Social Welfare ; Specialization ; Weights and Measures

OBJECTIVE: The use of oral hypoglycemic drugs in pregnant women has been limited and therefore there is scanty information on their safety. Concern about possible adverse effects of these drugs on the fetus led us to collect the cases of unintentional fetal exposure to oral antidiabetic agent during embryogenesis for comparision with an appropriately matched control group from the same clinic population. METHODS: Eight type 2 diabetic pregnant women with accidental exposure to oral antidiabetic agent during early pregnancy and 20 type 2 diabetic pregnant women matched for age, weight, and glycemic control but not exposed to oral antidiabetic agent were studied retrospectively. RESULTS: Three neonates (38%) in the exposed group had congenital malformations and still birth, compared with 5 (25%) in the control group (Odds ratio 1.8 (0.2-13.8), P>0.05). In the control group, the mean of HbA1c of 5 mothers of neonates with anomalies and stillbirth were higher than that of 15 mothers of neonates without anomaly (8.8% vs 6.2%, p=0.1) and the anomalies were major congenital malformation including three congenital heart diseases (1 ventricular septal defect, 2 patent ductus arteriosus) and one renal agenesis. In the exposed group, the mean of HbA1c of 3 mothers of neonates with anomalies and stillbirth were higher than that of 5 mothers of neonates without anomaly (9.0% vs 6.3%, p=0.4) and the anomlies were urachal sinus and facial palsy which was not commonly described in diabetic embryopathy. CONCLUSION: Although this study, due to the limited number of pregnancies examined, does not exclude an association between treatment with oral antidiabetic agent at the time of embryogenesis and congenital malformations in the offspring, the risk of our results is lower than that of others. The final answer will demand a much larger number of pregnancies studied prospectively.
Embryonic Development* ; Facial Paralysis ; Female ; Fetal Diseases ; Fetus* ; Heart Diseases ; Heart Septal Defects, Ventricular ; Humans ; Hypoglycemic Agents* ; Infant, Newborn ; Mothers ; Parturition ; Pregnancy ; Pregnant Women ; Retrospective Studies ; Stillbirth

BACKGROUND: The effect of Video Display Terminals(VDT) Syndrome is well documented. The purpose of this study is to examine the difference in systemic subjective symptoms between long term users of computers with that of the general population and to help plan to avoid the risk of developing Video Display Terminal Syndrome. METHOD: Data was collected for this study between August 1996 and February 1997. Two groups consisting of seventy(70) long term computer users(Exposed Subjects) and fifty nine(59) non users (Non Exposed Subjects), were selected for the survey. Data was gathered from the exposed subjects through their response to the survey questionnaire posted on the internet requiring detailed responses concerning ten systemic subjective symptoms that were experienced as a result of the long term exposure to VDT. Data was gathered from the non exposed subjects through written responses to the questionnaire. RESULTS: Among the more significant difference was the experience of ocular symptoms among the exposed group. The exposed group experienced in descending order eleven items of ocular symptoms. Congestion, strain, decreased visual acuity, ocular pain, and dryness. Among seven items of lifestyle, the exposed group characteristically exercised less(P<0.05) and did more home activity (P<0.05), characteristically lead healthier life than the non exposed group. Participation in exercise differed most among the groups. The exposed group participating in moderate exercise scored 517+/-551.6 compared to the non exposed group which exercised very vigorously(p<0.05). In comparison of subjective symptom and life styles per daily exposure time(over 8,10,16 hours daily) there was significant difference between 8 and 10hour exposers only in the stress item(P<0.05). In the exposure group there were less cardiovascular symptoms(P<0.05) due to more art activity(P<0.05), more cardiovascular symptoms and less sleep activity(P<0.001) and more ocular symptoms(P<0.05) due to higher levels of stress. CONCLUSIONS: By exercising, exposers can decrease the respiratory symptoms, and by seeking methods that enable efficient management of work time, the subjects can benefit from the reduced work time, and by seeking methods so that one receive less stress and can resolve them they can reduce their ocular symptoms, sleep problems, cardiovascular symptoms. And in their spare time, the subjects can be recommended to involve in art activity for each person, through PC indirectly. Designing the development of cyber gallery, museum, literature room, concert can reduce the oecur-rence rate of cardiovascular symptoms.
Computer Terminals ; Estrogens, Conjugated (USP) ; Humans ; Internet ; Life Style* ; Museums ; Visual Acuity ; Surveys and Questionnaires

PURPOSE: Axillary lymph node (ALN) status is the single most reliable indicator of the prognosis in early-stage breast cancer. However, downstaging of both the primary tumor and ALN involvement by neoadjuvant chemotherapy results in loss of traditional prognostic criteria. This study was performed to evaluate the prognostic significance of various clinicopathologic features in patients with operable breast cancer treated with neoadjuvant chemotherapy. METHODS: From Feb. 1991 to Oct. 1998, 73 patients with breast cancers (tumor size>3 cm, or clinically axillary node positive) were treated with preoperative combination chemotherapy comprised of preoperative 3 cycles and postoperative 3 cycles of FEC or MMM. The median follow-up period was 53 months. To analyze the potential simultaneous effect of the significant predictors of disease-free survival (DFS) and overall survival (OS) identified by univariate analysis, those factors were entered into a Cox multivariate regression model. RESULTS: Clinical responses to neoadjuvant chemotherapy were as follows, CR, 17.8% (13/73); PR, 57.5% (42/73); SD, 21.9% (16/73); and PD, 2.7% (2/72). The clinical response to neoadjuvant chemotherapy and the number of residual metastatic ALN were the only independent predictors of disease-free survival and overall survival. Patients with clinically complete response to neoadjuvant chemotherapy had a excellent 3-year DFS (100%) and 5-year OS (100%). In patients with a partial response, the number of metastatic ALN further stratified the patients with respect to DFS (p=0.003). Also, in patient with a stable disease, the number of metastatic ALN further stratified the patients with respect to DFS (p=0.000) and OS (p=0.000). Those with a progressive disease had a poor DFS and OS. CONCLUSION: Only the clinical response to neoadjuvant chemotherapy and the absolute number of metastatic ALN identified at surgical staging were the independent predictors of DFS and OS. Thus patients with partial or minor response can be further stratified with respect to DFS and OS by the number of involved ALNs.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Drug Therapy* ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Lymph Nodes ; Prognosis

BACKGROUNDS: Korean Activities of Daily Living(K-ADL) scale was developed to measure the elderly function. The aim of the present study was to establish the validity and reliability of Korean Activities of Daily Living(K-ADL) scale. METHODS: Clinical validity and convergent validity was tested. Reliability was tested by internal consistency(Cronbach's alpha), two weeks test-retest method, and interrator correlation. RESULTS: Cronbach's alpha was 0.937. 2 weeks test-retest correlations in all 7 items were higher than 7.0. Interrator agreements were high in all 7 items(h=0.86~1.0). Nonnal control group had lower scores than patients group in all 7 items(p=0.000). Correlation coefficients between K-ADL score and braindisability grade was between -0.465(eating) and -0.696(bathing)(p=0.000). CONCLUSIONS: Korean Activities of Daily Living(K-ADL) scale is a valid and reliable instrument. In the future, the studies showing an association between K-ADL and mortality, prognosis are needed.
Activities of Daily Living ; Aged ; Humans ; Korea ; Mortality ; Prognosis ; Reproducibility of Results*

Result and complications were evaluated in 28 eyes of 28 patients who had undergone pneumatic retinopexy for rhegmatogenous retinal detachment from December 1994 to May 1995 and were followed for at least 4 months. Twenty four eyes were phakic, one eye aphakic and three eyes pseudophakic. 0.3mlof perfluoropropane(4 eyes)or 0.45ml of sulfur hexafluoride(24 eyes)was injected. Mean follow-up time was 33.3 months. Perioperative complications included subconjunctival gas in 2 eyes, subretinal gas in 1 eye and delayed absorption of subretinal fluid in 5 eyes. Retinal reattachment was obtained in 22 eyes(79%) and final reattachment rate was 100% with an additional procedure of scleral buckle(4 eyes)or pars plana vitrectomy(2 eyes). Final visual acuity improved in 25 eyes(89%), and decreased in 2 eyes. Postoperatively following complications were noted;mild proliferative vitreoretinopathy(3 eyes), epiretinal membrane(1 eye), central retinal artery occlusion(1 eye), nucleosclerosis(4 eyes)and cataract operation(2 eyes). This result suggests that pneumatic retinopexy could be a good method for the treatment of rhegmatogenous retinal detachment.
Absorption ; Cataract ; Follow-Up Studies ; Humans ; Retinal Artery ; Retinal Detachment ; Retinaldehyde ; Subretinal Fluid ; Sulfur ; Visual Acuity

PURPOSE: Nodal involvement has long been known to represent the single most reliable indicator of the prognosis in early-stage breast cancer. In common parlance, high-risk node-positive breast cancer has generally been used to describe patients who have involvement of ten or more axillary lymph nodes (10 LN). Patients with 10 LN clearly have a strikingly high risk of recurrence and death. Thus we tried to evaluate the clinical courses of breast cancer patients with more than 10 positive axillary lymph nodes. METHODS: Of 587 breast cancer patients operated on at Chungnam National University Hospital from Feb. 1992 to Nob. 1999, 31 cases (5.3%) showed involvement of more than 10 axillary lymph nodes. We evaluated the clinical courses of these patients and differences in survival related to clinical and pathologic vaiables. Survival was calculated using the Kaplan-Meier method. RESULTS: The mean age of the patients was 50 14 years. A mastectomy was performed in 28 cases (90.3%), and a breast conserving operation in 3 cases (9.7%). The mean tumor size was 4.8 2.5 cm. The mean number of removed axillary LN was 23.5 10.2 (10-52), and the mean number of positive axillary LN was 20.0 10.1 (10-51). At a median follow-up of 30.5 months, 23 cases (74.2%) of recurrence were noted. Among these 69.6% (16/23) showed distant metastases as a first recurrence. The 3-year and 5-year disease-free survivals were 28.6% and 22.9%, respectively. The 3-year and 5-year expected overall survivals were 53.7% and 41.8%, respectively. There were significantly more recurrences in patients who had given up adjuvant chemotherapy than patients who had completed 6 cycles of FEC or MMM. Also, significant survival benefits were noted in patients who were treated using combination chemotherapy with taxane plus cisplatin after recurrence. CONCLUSION: Breast cancer patients with 10 LN have a strikingly high risk of recurrence. Six (6) cycles of adjuvant chemotherapy with FEC or MMM was a controllable variable for lowering the risk of recurrence. Also, combination chemotherapy with taxane and cisplatin was a controllable variable for increasing survival after recurrence.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Chungcheongnam-do ; Cisplatin ; Disease-Free Survival ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Mastectomy ; Neoplasm Metastasis ; Prognosis ; Recurrence

PURPOSE: Nodal involvement has long been known to represent the single most reliable indicator of the prognosis for early-stage breast cancer. In common parlance, high-risk node-positive breast cancer has generally been used to describe patients who have involvement of ten or more axillary lymph nodes (10+LN). Breast cancer patients who had 10+LN clearly have a strikingly high risk of tumor recurrence and death. Thus we tried to evaluate the clinical courses of breast cancer patients who had more than 10 positive axillary lymph nodes. METHODS: Of the 587 breast cancer patients who were operated on at Chungnam National University Hospital from February 1992 to November 1999, 31 cases (5.3%) showed involvement of more than 10 axillary lymph nodes. We evaluated the clinical courses of these patients and the differences in survival according to the clinical and pathologic vaiables. Survival was calculated using the Kaplan-Meier method. RESULTS: The mean age of the patients was 50+/-4 years. A mastectomy was done in 28 cases (90.3%), and a breast conserving operation was done in 3 cases (9.7%). The mean tumor size was 4.8+/-.5 cm. The mean number of removed axillary Lymph Nodes was 23.5+/-0.2 (range:10-52), and the mean number of positive axillary LNs was 20.0+/-10.1 (10-51). At a median follow-up of 30.5 months, 23 cases (74.2%) of recurrence were noted. Among these 23 cases (69.6%) showed distant metastases as the first recurrence. The 3-year and 5-year disease-free survivals were 28.6% and 22.9%, respectively. The 3-year and 5-year expected overall survivals were 53.7% and 41.8%, respectively. There were significantly more recurrences in patients who had given up taking their adjuvant chemotherapy than for those patients who had completed 6 cycles of FEC or MMM. Also, significant survival benefits were noted in those patients who were treated using a combination chemotherapy with taxane plus cisplatin after their tumor recurrence. CONCLUSION: Breast cancer patients with 10+LNs have a strikingly high risk of tumor recurrence. Six cycles of adjuvant chemotherapy with FEC or MMM was a controllable variable for lowering the risk of tumor recurrence. A combination chemotherapy with taxane and cisplatin was also a controllable variable for increasing survival after tumor recurrence.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Chungcheongnam-do ; Cisplatin ; Disease-Free Survival ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Mastectomy ; Neoplasm Metastasis ; Prognosis ; Recurrence