No abstract available.

No abstract available.

Harrington Instrumentation and Spinal Fusion to treat the unstable fracture and fracture-dislocation of the thoraco-Iumbar spine is a very effective method. This method not only decompresses the spinal cord and nerve roots by anatomical reduction and preserves spinal stability, but also makes possible early rehabilitation and prevention of complications. A clinical study was made of twelve patients who were hospitalized and treated at the Department of Orthopaedic Surgery, Chung-Nam National University Hospital from Oct. 1978 to J une 1980. The following results were obtained: 1. Of twelve patients, five(42%) had a flexion-compression fracture, four(33.3%) had a shear fracture-dislocation, two(16.7%) had a flexion-rotational fracture, and one(8.3%) had a bursting fracture. 2. Seven(58%) had a complete neural deficit and five (42%) had an Incomplete neural deficit. Two (28%) of the seven patients with complete neural deficit showed slight neurological recovery, but two patients(40%) with incomplete neural deficit gained complete recovery. 3. Correction of the kyphotic deformity was 16 degrees on the average, and the displacement was completely corrected in five of the six patients. 4. During the follow-up period, there was a final loss of about five degrees (range 3-16 degree) of kyphotic correction In our patients and there was no difference in loas of correction between laminectomy group and control group. 5. After an average of 18 postoperative days, ambulation was started, and acute hospital days were 77 days on the average. 6. There was no difference in spinal fusion rate between brace-wearing group (4 cases) and cast Immobilized group (8 cases). 7. Two cases (16.6%) of the twelve cases showed spontaneous interbody fusion.
Clinical Study ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Laminectomy ; Loa ; Methods ; Rehabilitation ; Spinal Cord ; Spinal Fusion ; Spine ; United Nations ; Walking

Substantial ACL ruptures are not common in adolescence or childhood. During this period, ACL tibia avulsion fractures are more common than substantial ACL ruptures are. However, recent advancements in MRI and increases in adolescent sports activity have led to increased diagnosis of substantial ACL ruptures. Many physeal-sparing ACL reconstruction methods have been reported. However, some physeal-sparing ACL reconstructions are associated with poor outcomes because of laxity in the reconstructed ligament and discordance in the isometric point. We report a 14-year-old male patient with a chronic substantial ACL rupture and a longitudinal medial meniscus tear who was treated with ACL reconstruction and all-inside meniscal repair, which spares the femoral physis and reduces tibia physeal injury with an Achilles allograft.
Adolescent ; Anterior Cruciate Ligament Reconstruction ; Humans ; Ligaments ; Male ; Menisci, Tibial ; Rupture ; Sports ; Tibia ; Transplantation, Homologous

PURPOSE: Older patient populations commonly have cognitive impairment, which might impact decisional capacity. We examined patients and family caregivers preferences for family involvement in treatment decision making assuming different level of cognitive impairment, and sought to explore the factors associated with the preferences and the degree to which patients and family members agree on preferences. MATERIALS AND METHODS: A total of 358 elderly cancer patient and caregiver dyads were recruited from the 11 cancer centers in Korea andwere asked to express their preferences forfamily involvement in treatment decision making using hypothetical scenarios with three different levels of cognitive status (intact, mild impairment, and severe impairment). RESULTS: Both patients and family caregivers preferred greater family dominance in treatment decision makingwith the increasing the level of cognitive impairment (39.7%, 60.9%, and 86.6% for patients and 45.0%, 66.2%, and 89.7% for caregivers in each scenarios). Patient and family caregiver concordance in decisional control preference was small for all three scenarios (weighted κ=0.32, κ=0.26, and κ=0.36, respectively). Higher patient education was associated with preference for patient dominance in treatment decision in conditions of both mild and severe cognitive impairment. The association of higher patient education and patient-caregiver preference concordance was positive with intact cognition, while it was negative with severe cognitive impairment. CONCLUSION: Decision control preferences were affected by hypothesized cognitive status of the patients. Findings from our study would be helpful to develop effective strategy for optimizing family involvement in cancer treatment decision in the context of deteriorating cognitive function of the patients.
Aged ; Caregivers* ; Cognition Disorders ; Cognition* ; Decision Making* ; Humans ; Korea ; Patient Education as Topic

PURPOSE: Delivering bad news is a task that occurs in most medical practices, rendering communication skills essential to competent patient care. The purpose of this study was to identify factors that are associated with scores on an assessment of medical students' communication skills in delivering bad news to help develop more effective curricula to enhance these essential skills. METHODS: One hundred fifty-four fourth-year medical students at Pusan National University were included. Skills for delivering bad news were assessed using the SPIKES protocol in the CPX. The students were categorized into three main groups according to total scores: 'Exceeds expectations (E)', 'Meets expectations (M)', and 'Needs development (N)'. Personal experiences with misfortune and attitudes toward breaking bad news were surveyed, and school records were collected. The differences between the E and N groups were analyzed based on performance test and survey. RESULTS: Compared with students in the N group, E group students acquired significantlyhigher scores on the items of Perception, Invitation, a division of Knowledge, Empathy and Strategy, and Summary but not on Setting and a part of Knowledge. E group students had better records in classes and clerkships. There were no differences in personal experiences and attitudes toward breaking bad news between the groups. CONCLUSION: Personal experience with delivering bad news does not guarantee better communication, and attitudes toward this task do not influence student performance. We expect that deliberate educational programs will have a positive impact on improving communication skills for delivering bad news.
Curriculum ; Empathy ; Humans ; Patient Care ; Personality Inventory ; Professional-Family Relations ; Students, Medical