We have investigated a series of 45 acute traumatic hemarthrosis of the knee between Jan. 1989 and Jan. 1993 at National Medical Center. All the patients who had normal findings on plain X-ray with hemarthrosis underwent arthroscopic examination under anesthesia. The arthroscopic results were as follows. 1. There were 14 cases(31%) of anterior cruciate ligament(ACL) tear, a case(2%) of avulsion fracture of tibial spine, 13 cases(29%) of lateral meniscus tear, 8 cases(18%) of medial meniscus tear, a case(2%) of osteochondral fracture of patella, and 8 cases(18%) showed no specific injury of internal structure. 2. The positive predictive value of Lachman and anterior drawer tests under anesthesia was 93% and 92%, respectively. 3. The positive predictive value of McMurray tests for medial and lateral menisci was 33% and 64%, respectively. 4. We concluded that a traumatic hemarthrosis indicated a significant knee injury and arthroscopy allowed a more accurate diagnosis of injury to joint structure.
Anesthesia ; Arthroscopy ; Diagnosis ; Hemarthrosis ; Humans ; Joints ; Knee Injuries ; Knee ; Menisci, Tibial ; Patella ; Spine ; Tears

PURPOSE: The purpose of this research was to describe the decision making of nurses in a VIP ward. METHOD: The methodology of collecting and analyzing the data was based on the grounded theory of Strauss and Corbin (1998). The data were collected through an in-depth interview, which were audio-taped and transcribed. The data were collected from 10 nurses from July to November 2007. RESULTS: The core category on VIP ward nurses' decision making was named as "adjusting with flexibility and deepened insight." The causal condition was established by 'the patients who wanted to be treated specially.' The contextual conditions included 'caring patients from various departments,' 'differences depending on the nurses' clinical experience,' and 'client-centered atmosphere in the VIP ward.' The intervening conditions included 'problem solving styles of nurses', 'attitudes of patients and family members', 'nurse-doctor relationships', and 'accessibility to information.' It was confirmed that nurses changed their action-interaction strategies depending on the intervening conditions, thus resulted in the nurses' role conflict and the need to expand their consciousness. CONCLUSION: The result of this study indicates that nurse's decision making depends on their experiences and the nature of social context in which nursing occurs.
Atmosphere ; Consciousness ; Decision Making ; Humans ; Pliability ; Qualitative Research

We investigated the 1,004 workers who worked in a automobile factory to study the epidemiologic characterist of dermatoses due to cutting oils. Among the workers, 667(66.4%) answered the questionnaire. They are belong to 5 departments of the factory-the Engine-Work(86), Power train Assembly(17). We measured the oil mist concentration in air of the departments and examined the workers who had dermatologic symptoms. The results were follows; 1) Oil mist concentration; Of all measured points(52), 9 points(17.2%) exceeded 5mg/m3-the time-weighed PEL- and one department had a upper confidence limit(95%) higher than 5mg/m3. 2) Dermatologists examined 213 workers. 172 of them complained any skin symptoms at that time-itching(32.5%), papule(21.6%), scale(15.7%), vesicle(12.5%) in order. The abnormal skin site found by dermatologist were palm(29.3%), finger & nail(24.6%), forearm(16.2%), back of hand(8.4%) in order. 3) As the result of physical examination, we found that 160 workers had skin diseases. Contact dermatitis was the most common; 69 workers had contact dermatitis alone(43.1%), 11 had contact dermatitis with acne(6.9%), 10 had contact dermatitis with folliculitis(6.3%), 1 had contact dermatitis with acne & folliculitis, and 1 had contact dermatitis with abnormal pigmentation. Others were folliculitis(9 workers, 5.6%), acne(8, 5.0%), folliculitis & acne(2, 1.2%), keratosis(1, 0.6%), abnormal pigmentation(1, 0.6%), and non-specific hand eczema(47, 29.3%). 4) The prevalence of any skin diseases was 34.0 per 100 in cutting oil users, and 13.3 per 100 in non-users. Especially, the prevalence of contact dermatitis was 23.0 per 100 in cutting oil users and 4.3 per 100 in non-users. 5) We tried patch test(standard series, oil series, organic solvents) on 49 patients to differentiate allergic contact dermatitis from irritant contact dermatitis and found 20 were positive. 6) In a multivariate analysis(independent=age, tenure, kinds of cutting oil), the risk of skin diseases was higher in the water-based cutting oil user and both oil user than non-user or neat oil user(odds ratio were 2.16 and 2.78, respectively). And the risk of contact dermatitis was much higher at the same groups(odds ratio were 5.16 and 6.82, respectively).
Acne Vulgaris ; Automobiles ; Dermatitis, Allergic Contact ; Dermatitis, Contact ; Fingers ; Folliculitis ; Hand ; Humans ; Oils ; Physical Examination ; Pigmentation ; Prevalence ; Surveys and Questionnaires ; Skin ; Skin Diseases

Total knee arthroplasty is indicated for painful joints, with or without deformity, secondary to rheumatoid arthritis, osteoarthritis, traumatic arthritis, and certain other forms of nonseptic arthropathy. Many patients with arthritic knees have symetrical involvement and thus require a bilateral operation. Staged bilateral arthroplastis were performed with many drawbacks such as prolonged hospitalization, repeated anesthetic risks, and increased cost. Simultaneous bilateral arthroplasty under one anesthesia by two teams offers several advantages over staged procedure. We studied the results of 145 total knee arthroplasties, performed over a five-year period, to compare unilateral(group I;45 knees), staged bilateral(group II; 24 knees), and simultaneous bilateral arthroplasties(group III; 76 knees) by 2 team approach. Duration of mean follow-up was 1 year and 9 months. The results are as flollows; 1. The mean anesthetic times were 189 minutes, 312 minutes, and 218 minutes for the group I,II,III, respectively. 2. The mean blood loss was 1075ml for the group I, 1644ml for the group II, and 1902ml for the group III. 3. The hospitalization period was 74.1 days in two stage procedures, while it was 48.6 days in simultaneous bilateral procedures. 4. Knee scores by Knee Rating Scale of Hospital for Special Surgery were increased to 85.3 points, 80.7 points, and 85.4 points for group I,II,III, respectively. 5. There were no difference in complication among three groups. 6. Group III had advantages such as reduced anesthetic risk, reduced rehabilitation period, and decreased cost.
Anesthesia ; Arthritis ; Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Congenital Abnormalities ; Follow-Up Studies ; Hospitalization ; Humans ; Joints ; Knee ; Osteoarthritis ; Rehabilitation

Tibial nonunion is often associated with the soft tissue atrophy and the local circulatory disturbance, so it is important to minimize the soft tissue injury and maintain the stability at fracture site for bone union. We reviewed 29 cases of subcortical onlay bone grafts and plate fixations for the nonunion and delayed union of tibial shafts, from Jan. 1988 through Jan. 1994. The results were as follows. 1. Twenty-nine patients who had nonunion of the tibia underwent subcortical cancellous onlay bone graft and plating, and 28 fractures(96.6%) went on to union. 2. Subcortical elevation or shingling of cortical bone fragments of the tibial cortex, is advocated to provide sound biological condition in atrophic soft tissue envelope. 3. Narrow DCP encouraged early motion and reliably promoted obtaining anatomical alignment. So, in treatment of protracted tibial nonunion, especially in an area with deficient soft tissue or unyielding scar tissue, subcortical onlay bone graft and plate fixation is very useful method, result in good union and no skin problem.
Atrophy ; Cicatrix ; Humans ; Inlays ; Methods ; Skin ; Soft Tissue Injuries ; Tibia ; Transplants

Stress fracture of the metatarsal was first described as March fracture by Breithaupt, a Prussian military surgeon in 1855, According to the classical references, the second metatarsal is the most frequently involved and radiological evidence of fracture appears as late as several weeks. The purpose of this study is to document the incidence and clinical feature of march fractures in Korean military soldiers. From may 1991 to April 1994, at one military hospital in Korea, 52 march fractures in 46 patients were detected among infantry soldiers. There are different findings of fracture site and its clinical features from the previous foreign reports. 1. By physical examination, direct point tenderness on the location of the metatarsal shaft is characteristic, with careful history taking. 2. On roentgenographic examination, cortical fissuring or break is seen one week after onset of symptoms and external callus is seen from two weeks or at the latest four weeks. 3. The third metatarsal is the most frequently involved site(34 cases, 65.4%), and the second metatarsal is less frequent(12 cases, 23.1%) 4. The discrepancy between previous reports and present findings should be emphasized and analyzed in further study.
Bony Callus ; Fractures, Stress ; Hospitals, Military ; Humans ; Incidence ; Korea ; Metatarsal Bones ; Military Personnel ; Physical Examination

The posterior cruciate ligament, because of its location and axial role in knee function, was assumed to be a fundamental stabilizer for the knee joint. Reconstruction of the posterior cruciate ligament has been a demanding operation due to difficulties of appropriate graft material. Posterior cruciate substituing material should be biocompatible, durable, stress-strain capable and ease to be used. Achilles tendon autografts were thought to meet these criteria. Recently, we have advocated partial Achilles tendon autograft in reconstructive operation of posterior cruciate ligament with promising result. Posterior cruciate ligament reconstructions were done in 8 knees, with follow-ups ranging from 7 to 23 months, averaging 13 months. The results were as followings: l. Average preoperstive knee score was 46 and it was improved up to 88 after operation. 2. Among the 8 knees, 3 belonged to the excellent, 4 to good, and 1 to fair groups respectvely. 3. Achilles tendon autograft turned out to be a good substitute for the posterior cruciate deficient knee. The results were promising. Achilles tendon autograft regarded to be suitable for the posterior cruciate liagament reconstruction and desirable features of this autogenous graft included distinguished biocompatability, mechanical stability in fixation strength as well as stress-strain capability, and consistency in reproducible operative technique.
Achilles Tendon ; Autografts ; Follow-Up Studies ; Knee ; Knee Joint ; Posterior Cruciate Ligament ; Transplants

No abstract available.
Diagnosis, Differential*

No abstract available.
Phenotype*

BACKGROUND: Diabetes mellitus is a common condition, and the majority of patients have one or more cutaneous complications. Among them, xerosis is well known to be closely related to diabetics. The xerosis is inversely reflected upon skin surface hydration, the state of which can be exactly assessed with various investigating instruments, such as a hydrometer and corneometer. OBJECTIVE: Our purpose was to compare the hydration state of diabetics with normal persons by the use of a corneometer and hydrometer. METHODS: A total of 267 diabetics were asked whether they felt xerosis or pruritus. In a subgroup of 31 patients, the water content was evaluated and compared by the parameters of diabetic severity. Forty-one non-diabetics were selected for the normal control.
Diabetes Mellitus ; Humans ; Pruritus ; Skin* ; Water