There are many procedures for the treatment of acromioclavicular separation but there are still controversies concerning the best management of these injuries. The cases of 20 acromioclavicular separations and 3 distal end fractures of clavicle were treated by conservative method with modified Kenny Howard sling-halter using long arm cast at the department of Orthopedic Surgery, College of medicine,Ewha Womans University, during the thirty six months period from March 1982 to February 1985. The following results were obtained. 1. The average duration of immobilization was 5 weeks at the grade II of acromioclavicular separation and fracture of distal end of clavicle and 6 weeks at the grade III of acromioclavicular separation. 2. The functional results were 17 excellents(73.8%), 5 goods(21.9%), and 1 fair(4.3%). 3. The complications were 3 frozen shoulders(13.0%), 2 subluxations(8.6%), and 1 skin necrosis on the elbow(4.3%). 4. The authors immobilized the upper extremity with long arm cylinder cast of 90° flexion position instead of initial harness, so that it was applied easily and the patient felt very comfortable. 5. When the fracture and severe displacement were occurred at the midthird of the clavicle, it could be reduced and maintained with the long arm cylinder cast and strap.
Arm ; Clavicle ; Female ; Humans ; Immobilization ; Methods ; Necrosis ; Orthopedics ; Skin ; Upper Extremity

Adenoid basal carcinoma and adenoid cystic carcinoma of the uterine cervix are rare tumors that have often been regarded as a single entity. But adenoid basal and adenoid cystic carcinomas of the cervix differ from each other in their histology, treatment, and prognosis. We experienced 2 cases of these neoplasms, with 1 case in each category. Whereas adenoid basal carcinoma is a slow-growing, locally invasive lesion amenable to simply hysterectomy, adenoid cystic carcinoma is an aggressive tumor associated with regional lymph node involvement and late distant metastases. This study reviews the literature and formulates a program for the management of these rare lesions.
Adenoids* ; Carcinoma, Adenoid Cystic* ; Cervix Uteri* ; Female ; Hysterectomy ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

PURPOSE: The management of central venous catheters (CVCs) and catheter thrombosis vary among centers, and the efficacy of the methods of management of catheter thrombosis in CVCs is rarely reported. We investigated the efficacy of bedside thrombolysis with urokinase for the management of catheter thrombosis. MATERIALS AND METHODS: We retrospectively reviewed data from patients who had undergone CVC insertion by a single surgeon in a single center between April 2012 and June 2014. We used a protocol for the management of CVCs and when catheter thrombosis was confirmed, 5,000 U urokinase was infused into the catheter. RESULTS: A total of 137 CVCs were inserted in 126 patients. The most common catheter-related complication was thrombosis (12, 8.8%) followed by infection (8, 5.8%). Nine of the 12 patients (75%) with catheter thrombosis were recanalized successfully with urokinase. The rate of CVC recanalization was higher in the peripherally inserted central catheter (PICC) group (87.5%) than the chemoport group (50%). Reintervention for catheter-related thrombosis was needed in only 2.2% of patients when thrombolytic therapy using urokinase was applied. Age <60 years (P=0.035), PICC group (P=0.037) and location of the catheter tip above the superior vena cava (P=0.044) were confirmed as independent risk factors for catheter thrombosis. CONCLUSION: Thrombolysis therapy using urokinase could successfully manage CVC thrombosis. Reintervention was rarely needed when a protocol using urokinase was applied for the management of CVC thromboses.
Catheters ; Central Venous Catheters ; Humans ; Retrospective Studies ; Risk Factors ; Thrombolytic Therapy* ; Thrombosis ; Upper Extremity Deep Vein Thrombosis* ; Urokinase-Type Plasminogen Activator* ; Vena Cava, Superior

BACKGROUND: Patients undergoing ambulatory surgery under general anesthesia experience considerable levels of postoperative nausea and vomiting (N/V) after their discharge. However, those complications have not been thoroughly investigated in hand surgery patients yet. We investigated factors associated with postoperative N/V in patients undergoing an ambulatory hand surgery under general anesthesia and determined whether patients' satisfaction with this setting is associated with postoperative N/V levels. METHODS: We prospectively evaluated 200 consecutive patients who underwent ambulatory hand surgeries under general anesthesia to assess their postoperative N/V visual analogue scale (VAS) levels during the first 24 hours after surgery and their satisfaction with an ambulatory surgery setting. Potential predictors of postoperative N/V were; age, sex, body mass index, smoking behavior, a history of postoperative N/V after previous anesthesia or motion sickness, preoperative anxiety level and the duration time of anesthesia. We conducted multivariate analyses to identify factors associated with postoperative N/V levels. We also conducted multivariate logistic regression analyses to determine whether the N/V levels are associated with the patients' satisfaction with this setting. Here, potential predictors for satisfaction were sex, age, postoperative pain and N/V. RESULTS: Postoperative N/V were associated with a non-smoking history, a history of motion sickness and a high level of preoperative anxiety. Twenty-two patients (11%) were dissatisfied with the ambulatory setting and this dissatisfaction was independently associated with moderate (VAS 4-7) and high (VAS 8-10) levels of postoperative N/V and with a high level (VAS 8-10) of postoperative pain. CONCLUSIONS: Although most of the patients were satisfied with the ambulatory surgery setting, moderate to high levels of N/V were associated with dissatisfaction of patients with this setting, suggesting a need for better identifying and managing those patients at risk. The information regarding risk factors for N/V could help in preoperative patient consultation regarding an ambulatory hand surgery under general anesthesia.
Adolescent ; Adult ; Aged ; *Ambulatory Surgical Procedures ; Anesthesia, General ; Female ; Hand/*surgery ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Postoperative Nausea and Vomiting/*diagnosis ; Young Adult

OBJECTIVE: To compare the second and third cesarean section by clinical and statistical analysis. METHODS: From June 1993 to February 1997, we experienced 296 cases of the third cesarean section and 541 cases of the second cesarean section. We analyzed their incidence, age distribution, gestational week at operation, weight distribution of baby at birth, hemoglobin change, estimated blood loss during operation, obstetrical complication, combined operation, and degree of pelvic adhesion, presence of wound dehisence of uterus, post operative complication. RESULTS: Of the total deliveries, overall incidence of cesarean section was 51.4%, while the incidence of the second cesarean section was 16.0%, and that of the third cesarean section was 1.1%. In the third cesarean section the age group of 31-35 was most common(49.7%), and the most common gestational week at operation was 39th week(43.9%). In the third cesarean section, the hemoglobin change of 1.0g% less was most common(95.2%), and the most common amount of estimated blood loss was 400-600ml(61.0%). There was statistically significant difference of the blood transfusion rate between the third cesarean section(41 cases, 13.8%, p=0.04) and second cesarean section(27 cases, 5.0%). The most common combined operation in the third cesarean section was tubal ligation(51.7%), and the others were bladder wall repair(2.0%), cesarean hysterectomy(1.7%). In the third cesarean section, the incidence of mild intraabdominal adhesion was 16. 9% and that of severe adhesion was 11.8%. It was statistically significant compared to the second cesarean section. Among the complications of the third cesarean section, there were 9 cases of placenta accreta(3.0%), 4 cases of placenta previa totalis(1.4%), and 1 case of uterine rupture, uterine atony, uterine arterial rupture(0.3% each other), and did not proved statistical significance. CONCLUSION: In this study, we found that the rate of blood transfusion, cesarean hysterectomy, bladder wall repair, and the degree of intraabdominal adhesion were more common in the third cesarean section than second section. But, if pre- & postoperative management is adequate, maternal mobidity and neonatal mobidity is not affected.
Age Distribution ; Blood Transfusion ; Cesarean Section* ; Female ; Humans ; Hysterectomy ; Incidence ; Parturition ; Placenta ; Placenta Previa ; Pregnancy ; Urinary Bladder ; Uterine Inertia ; Uterine Rupture ; Uterus ; Wounds and Injuries

OBJECTIVE: The purpose of this study was to measure the symptom prevalence of acute pesticide poisoning among farmers in Gyeong-gi province and to investigate the occupational risk factors. METHODS: The subjects were 663 farmers using pesticide directly or indirectly and the survey was performed during 2013. 7. 11 - 2014. 8. 27. The data were analyzed by SPSS 21.0. RESULTS: The prevalence of acute pesticide poisoning was 6.63% and dizziness was the most common symptom. Acute pesticide poisoning was related with 'days of pesticide use per year','lifetime pesticide application days', 'the number of pesticide mixture' and 'type of farming'. CONCLUSION: It is necessary to manage and educate the pesticide poisoning-vulnerable group more systematically. Afterward additional study is needed to investigate the farming safety behavior and delicate amount of pesticide exposure.
Dizziness ; Poisoning* ; Prevalence* ; Risk Factors*

PURPOSE: To compare side-to-side difference (SSD) of anterior tibial translation in instrumented stress radiography for each series of anterior cruciate ligament (ACL)-injured subjects according to knee flexion angle. METHODS: Forty subjects who were suspected of having significant ACL injury by manual Lachman test and MRI were recruited for this prospective study. These subjects took stress radiographs for both knees with corresponding knee flexion of 10° (series M1) and 30° (series M2) using Telos stress device. Mean SSDs of M1 and M2 were compared. Sensitivities of M1 and M2 were assessed using the SSD ≥3mm or ≥5mm as a cutoff value. RESULTS: Mean SSDs in series M1 and M2 were 4.22 ± 3.72mm and 3.25 ± 3.30 mm, respectively (p < 0.001). When 3 mm of SSD was used as a cutoff value, sensitivities of series M1 and M2 were 47.5% (19/40) and 32.5% (13/40), respectively (p = 0.171). When 5mm of SSD was used as a cutoff value, sensitivities of series M1 and M2 were 45.0% (18/40) and 22.5% (9/40), respectively (p = 0.033). CONCLUSIONS Anterior tibial translation on stress radiographs using a Telos device is more prominent when knee flexion angle is 10° compared to that when knee flexion angle is 30°. However, stress radiography using Telos device, either at 10° or 30° of knee flexion, might not be suitable to make decision on surgical treatment due to relatively low sensitivities.