It is well known that the incidence of revision arthroplasty for the loosened total hip has been progressively increasing recently. And the problem is that the loosening rate of revision arthroplasty for the failed total hip replacement is much higher as compared with that of primary total hip replacement. In revision arthroplasty, Amstutz, in 1982, reported 9% incidence of mechanical failure and 43% incidence of femoral and 61% incidence of acetabular progressive radiolucencies with follow-up for an average of 2.1 years, and Pellicci, in 1985, reported 29% incidence of failure for total hip replacement that have been revised once in the radiolucent zone with the follow-up for an average 8.1 years, and Kavanagh, in 1985, reported that probable loosening occurred in 25% of revised acetabular components with follow-up for an average of 4.5 years. Cementless total hip replacement is successful in more than 90 of the primary cases for the last 5 years in our department. Therefore, not only in primary total hip replacement but also in the revision, it seems to be reasonable to perform the cementless total hip replacement as an alternative, particularlly, in young age group. During the period from April 1982 to December 1984, we have revised 12 loosened total hip replacement with cementless type. Average follow up was 1 year and 7 months. The age range of the patients was 23 to 64. The results are very promising without any evidence of loosening in all cases.
Acetabulum ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Hip ; Humans ; Incidence

PURPOSE: This study was done to use preceptorship in an ordered elective clinical nursing practice and to evaluate the effects on student nurses, nurses managers and preceptors. METHOD: The participants in this study were 208 students who were majors in the department of nursing, G college located in Inchon Metropolitan City, 54 nurse managers and 187 preceptors from 11 general hospitals. The instrument was a questionnaire which included general characteristics of participants, and 21 items to evaluate the ordered elective clinical nursing practice on a scale of 1 to 4. Data were collected from October 23 to November 7. 2004. Data analysis was done using SPSS WIN with the following statistics: frequency, percentage, mean, standard deviation, and ANOVA. RESULTS AND CONCLUSIONS: The results of data analysis were as follows: There were meaningful differences in the evaluation scores of the ordered elective clinical nursing practice with preceptors between students (3.33+/-.39) and nurse managers (3.33+/-.28) and preceptors (3.23+/-.38). Evaluation scores for the ordered elective clinical nursing practice with preceptors were categorized as follows: necessity and appropriateness, practice control and management, material for practice, practice report assignment and evaluation, practice ability improvement and connection with getting a job, and contribution to the hospitals.
Hospitals, General ; Humans ; Incheon ; Nurse Administrators ; Nursing Education Research ; Nursing* ; Preceptorship* ; Surveys and Questionnaires ; Statistics as Topic

No abstract available.

No abstract available.
Rabbits*

This study was done to evaluate the quality of clinical nursing care using the variables of structure, process, and outcome and to analyze the relationship between the variables. This study also explored which variables are validating indicators to evaluate the quality of nursing care. The results analyzed by multiple regression showed that, generally structural variables did not contribute to the variance in outcome scores, but process variables of nursing care contributed significantly to the outcome variable of patient satisfaction. A combination of structure and process variables more than structural variables alone. Also, patient satisfaction and hospital preference were significantly related to each other. Therefore, if nursing quality evaluation relies solely upon on structural variables such as number of available nurses and workload, it would be inaccurate because process variables of nursing care are strongly related to outcome variables and the two categories of structure and process variables helped to strengthen the relationships. Thus, it is important to focus on variables of structure, process, and outcome together in evaluating nursing care quality.
Nursing Care* ; Nursing* ; Patient Satisfaction

PURPOSE: To evaluate the prevalence of the opacification of paranasal sinuses and to correlate the prevalence and severity of the sinus opacification with presence of upper respiratory infection (URI) in infants and children using CT. MATERIALS & METHODS: We analyzed CT scans of 162 children aged under 16 who have no signs and symptoms of paranasal sinusitis. Both sides of maxillary and ethmoidal sinuses were evaluated. We scored from 0 to 3 according to the degree of soft tissue opacification of each sinus and then summed up the scores of each sinus. We divided the children into 5 groups according to their age. We paid particular attention to the following respects: 1) the prevalence of the opacification of the paranasal sinuses in each group; 2) the difference in the prevalence between the children with and without URI ;3) the correlation between the severity of the sinus opacification and the presence of URI. RESULTS: Of 162 children, one or more paranasal sinus opacification was noted in 76(47 %):31(65%) less than 1 year old;11(52%) between 1 and 2 years old;16(53%) between 2 and 6 years old ;15(28%) between 6 and 12 years old;and 3(33%) above 12 years old. In children less than 1 year old, no significant difference in the prevalence of the sinus opacification was found between URI-positive(71%) and URI-negative(58%) subgroups. In chilren between 1 and 12 years old, although the prevalence of the sinus opacification in URI-positive subgroups was much greater than that in URI-negative subgroup, statistically significant difference was noted only in children between 2 and 6 years old. As to the correlation between the severity of the sinus opacification and the presence of URI, these was a statistically significant difference in children between 2 and 6 years old and between 6 and 12 years old. CONCLUSION: Although the exact pathophysiology is not fully understood, the opacification of the paranasal sinuses is not an uncommon finding at CT in children without the signs and symptoms of sinusitis. We think that the clinical correlation is essential in determining the diagnosis and treatment plan in cases that the sinus radiographs or CT scans show the abnormal findings.
Child* ; Diagnosis ; Humans ; Infant* ; Paranasal Sinuses ; Prevalence* ; Sinusitis* ; Tomography, X-Ray Computed

In patients disabled by severe rheumatoid and degenerative arthritis of both knees, bilateral total knee arthroplasty(TKA) afforded much functional improvement in pain relief and function. Postoperative results of bilateral TKA was described as being similiar to those observed among patients with single joint replacement. The purpose of this study is to evaluate the etiology and postoperative result of bilateral TKA performed on 32 knees in 16 patients at Department of Orthopedic Surgery, Seoul National University Hospital from Mar. 1985 to Oct. 1988. In our series, there were 15 females and only 1 male, their mean age was 53 years. Duration of follow up was ranged from 1 to 4 years and 5 months being average 1 year and 6 months. The results were as follow. 1. Cheif complaints were pain in 18 cases(100%) and difficulty in walking in 15 cases(82%). 2. Preoperative etiology was rheumatoid arthritis in 11 cases and degenerative arthritis in 7 cases. 3. Knee joint function by HSS(Hospital for Special Surgery) knee rating score was increased from 44.6 points preoperatively to 81.2 points postoperatively. 4. The tibiofemoral angle was changed from 1.4 degree varus to 4 degree valgus. 5. The prothesis type used were PFG(Press Fit Condylar) in 22 knees, Miller-Galante in 8 knees, AMK in 3 knees, PCA in 2 knees and unicompartmental type in 1 knee. 6. Complication were 1 case of knee fusion due to concomittant tuberculous arthritis and mild joint effusion in 6 knees. 7. Bilateral one-stage arthroplasty may be considered as an alternative procedure.
Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Female ; Follow-Up Studies ; Humans ; Joints ; Knee ; Knee Joint ; Male ; Orthopedics ; Osteoarthritis ; Passive Cutaneous Anaphylaxis ; Seoul ; Walking

Ilizarov device is a circular external skeletal fixator with crossed transfixation wires and connecting rods. Its stability depends on the tension in the wire and the spatial orientation of the fixator frame. It provides extreme versatility for correction of three dimensional complex deformities including angulation, rotation, shortening and translation. In an attempt to identify the various factors that contributed to the outcome and the complications of lengthening, we reviewed the first 19 cases of leg lengthening by the Ilizarov technique in 17 patients with leg length inequality or dwarfism. Simultaneous correction of the three dimensional deformities was also aimed at in 13 patients, and osteosynthesis of congenital pseudarthrosis of the tibia in 2 patients. Follow-up periods averaged 1.6 years, ranging from 1 year to 2.8 years. The results were summarized as follows : 1. The amount of lengthening averaged 5.2cm, ranging from 2.0cm to 9.8cm. 2. The percentage increase was 27%, ranging from 9% to 58%. 3. The average healing index (month/cm) was 1.3months/cm and it was higher in the groups that had premature consolidation, complete osteotomy, single level corticotomy and neurologic compromise as compared with the groups that had adequate corticotomy, double level corticotomy and no neurologic complication. 4. The desired lengthening was obtained in 14 cases. Simultaneous correction of the deformities and osteosynthesis for nonunion were also achieved satisfactorily during lengthening. 5. There were sixteen cases of problems (84%), which were pin tract inflammation (7 cases), Transient senrory change (3 cases), knee joint flexion contracture (2 cases), nut breakage (2 cases). There were thirteen cases of obstacles (68%), which were equinus deformity(5 cases), premature consolidation (3 cases), pathologic fracture (3 cases), and delayed consolidation (2 cases). There was only one ture complication case. In conclusion, the Ilizarov technique was very effective for leg lengthening in children, particularly when three dimensional deformities were combined with leg length shortening. But a thorough knowledge of the Ilizarov technique and meticulous care during lengthening are mandatory to prevent the pitfalls and complications.
Child ; Congenital Abnormalities ; Contracture ; Dwarfism ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Ilizarov Technique ; Inflammation ; Knee Joint ; Leg Length Inequality ; Leg ; Nuts ; Osteotomy ; Pseudarthrosis ; Tibia

We investigated the effect of tibial lengthening by means of callotasis on enchondral growth of the tibia, Ninety-nine 5-week-old immature rabbits were separated into five groups according to the percentage of lengthening : GroupI(10% lengthening), Group II (20% lengthening), Group III (30% lengthening), Group IV (40% lengthening), Group V (sham operation without lengthening). Osteotomy of the tibia and fibula was made at the proximal metaphysiodiaphyseal junction. Distraction was started at the rate of 0.25mm twice a day from the third postoperative day to simulate the currently accepted callotasis. In Group I, II, and V, there two were no statistically significant differences in the growth rates between the left operated and the right normal tibiae. In contrast, the ratios of left over right tibial length decreased significantly in Group III (4.8%), and Group IV (8.6%) at the completion of lengthening(p < 0.0001), and remained decreased until near skeletal maturity. Histomorphometric study revealed that, in Group III and IV, there were statistically significant decreases in the ratios of the thickness of left over night tibiae at both proximal and distal growth plate(p < 0.0001). Immunohistochemical study also revealed that, in Group III and Group IV, the ratios of left over right bromodeoxyuridine(BrdUrd) labeling percentage decreased significantly (p < 0.0001). In summary, when the tiba was lengthened 30% or more, retardation of enchondral growth was evident, which persisted from the time of completion of lengthening to near skeletal maturity. It is postulated that unphysiologically increased pressure on the growth plate due to excessive bone lengthening may be closely related with the inhibition of enchondral growth.
Bone Lengthening ; Fibula ; Growth Plate ; Osteogenesis, Distraction ; Osteotomy ; Rabbits ; Tibia

Congenital dificiency of the fibula has a clinical spectrum ranging from partial deficiency to complete absence. The major clinical problems are the severe leg-length discrepancy and the deformities of the foot and ankle. The traditional method of compensation for severe leg-length discrepancy has been ablation of the forepart of the foot by the Symeor Boyd method and subsequent fitting of a prosthesis. The development of newer techniques of limb-lengthening with Ilizarov apparatus in recent years has changed the concept of treatment. The authors have treated 5 patients with congenital deficiency of the fibula by the Ilizarov lengthening method at the Department of orthopedic Surgery, Seoul National University Hospital between Feb, 1989 and Dec. 1992. Five patients had leg length shortening rainging from 6.0cm to 9.3cm(average, 7.6cm) and had surgery at an average age of 9.1 years. The leg length discrepancy was projected to average 10.7cm(range, 8.8cm-13.3cm). Leg length equalization was achieved by one stage lengthening in 4 of 5 patients with an average 8.3cm(range, 6.0cm-12.4cm) lenthening. In one patient, there was 3.5cm residual shortening even after 8.1cm of lengthening. Complications were encountered in 4 patients: recurrent foot deformities in 3 cases, temporary knee flexion contracture in 3 cases, and stress fracture at the regenerated site in 1 case. In all 3 Acterman and Kalamchi's Type II cases, the width of distal tibial physis apparantly narrowed down after lengthening of average 9.3cm(average 51.8% lengthening, 33.4-73%). We found that in congenital deficiency of the fibula the Ilizarov method was effective to achieve lengthening and to correct deformities, unless there were severe shortening of the leg and complex three-plane deformity of the foot and ankle. However, excessive lengthening in one stage should be avoided to prevent recurrence of valgus deformity and growth plate damage of the tibia.
Ankle ; Compensation and Redress ; Congenital Abnormalities ; Contracture ; Fibula ; Foot ; Foot Deformities ; Fractures, Stress ; Growth Plate ; Humans ; Ilizarov Technique ; Knee ; Leg ; Methods ; Orthopedics ; Prostheses and Implants ; Recurrence ; Seoul ; Tibia