After the discovery of penicillin by Fleming, a great improvement in the treatment of osteomyelitis was obtained and the mortality rate in the acute stage was markedly decreased. But, because of abuse of the antibiotics and resulting resistant organisms to antibiotics, the incidence of acute hematogenous osteomyelitis tends to increase recently. During the period of 6 years extending from 1979 to 1984, we have treated 45 cases of acute hematogenous osteomyelitis in children and clinical analysis was made about the causes of the development of chronic osteomyelitis with particular emphasis on the time interval from onset to treatment, and on the operative methods in the surgical treatments. The following results were obtained; 1. The incidence in males was 1.5 times greater than females. 2. Age incidence showed that it was most prevalent in the age group of 6 to 15 with 66.2% of the total cases. 3. The most common sites of the involvement was femur and tibia in orders. 4. Most of cases showed pain, local tenderness, pyrexia, loss of motion, swelling, and heat of the involved limbs. 5. Among the causative organisms, staphylococcus aureus was most prevalent one. 6. Cephalosporin, methicillin, gentamicin showed the highest sensitivity while penicillin showed marked resistancy (80%). 7. Time interval from onset to treatment was persistently an important factor in the development of chronicity. 8. Bone fenestration was the best method in the surgical treatments of acute hematogenous osteomyelitis in children. 9. Early diagnosis, adequate antibiotics, and early surgical decompression and drainage (esp. bone fenestration) were considered to be the essential part of management of acute hematogenous osteomyelitis in preventing its chronicity.
Anti-Bacterial Agents ; Child ; Decompression, Surgical ; Drainage ; Early Diagnosis ; Extremities ; Female ; Femur ; Fever ; Gentamicins ; Hot Temperature ; Humans ; Incidence ; Male ; Methicillin ; Methods ; Mortality ; Osteomyelitis ; Penicillins ; Staphylococcus aureus ; Tibia

Twenty-six cases of Colles fracture were treated with closed reduction and percutaneous K-wire fixation under C-arm field and then wrist was immobilized by sugar tong splint and then short arm splint from Jan. 1982 to Dec. 1985 at the department of orthopaedic surgery of St. Benedict hospital. A prospective study was made and evaluated under the subjective and objective criteria of Gartland and Werley, and the objective criteria of Scheck. The result of this study were as follow: 1. The incidence of Colles fracture was highest in 3rd decade(26.9%) and 7th decade(23.1%) respectively. In the 3rd decade the reason for the highest incidence was the job-related accident during the productive age and they were male patients. 2. The main cause of the injury was falling accident comprising of 53.8% and the male to female ratio was about equal. 3. Among the 26 cases treated with the percutaneous K-wire fixation, the result was satisfactory in 92.2% but was unsatisfactory in one case with severe comminuted fracture. 4. The percutaneous K-wire fixation for Colles fracture had less complication and more advantages such as the early disappearance of edema by early exercies, the early returning of range of motion of joint to normal, and the comfortable cast immobilization in neutral position of wrist. 5. The percutaneous K-wire fixation for Colles fracture was applicable to the concept that the anatomical reduction and maintenance would lead to the improvement of the joint function. 6. The percutaneous K-wire fixation for Colles fracture was indicated when neurologic sign developed after reduction of fracture by classic methord and when the exercise of joint was required in the old age. 7. When the articular surface of the radius was severely comminuted and the distal radius became severely osteoporotic, the result from the use of percutaneous K-wire fixation was also poor. In this case we considered the use of an external fixator.
Accidental Falls ; Arm ; Clinical Study ; Colles' Fracture ; Edema ; External Fixators ; Female ; Fractures, Comminuted ; Humans ; Immobilization ; Incidence ; Joints ; Male ; Neurologic Manifestations ; Prospective Studies ; Radius ; Range of Motion, Articular ; Splints ; Wrist

PURPOSE: The number of resected lymph nodes can influence the current N staging. This study examined the significance of the metastatic lymph node ratio on the survival of patients with pT2 gastric cancer. METHODS: The records of 176 patients who had undergone curative gastrectomy and diagnosed with pT2 gastric cancer by pathology, between February 1990 and October 2002 were retrospectively reviewed. Those patients with other organ metastases or those who had undergone a dissection of less than 15 lymph nodes were excluded. The clinicopathologic prognostic variables were evaluated using the SPSS statistical program. RESULTS: There were 115 men and 61 women with a mean age of 59 years. The median survival period was 93 months (2~184 months). Metastatic lymph nodes were found in 100 cases (56.8%), a mean of 34.6 lymph nodes were dissected, a mean of 3.2 lymph nodes metastasized, and a mean metastatic lymph node ratio of 0.09 was found. According to the UICC TNM classification, the number of stage IB (N0) cases was 76 (43.2%), stage II (N1) was 74 (42.0%), stage IIIA (N2) was 18 (10.2%), and stage IV (N3) was 8 (4.5%). The overall 5-year survival rate was 75.2%. According to the UICC TNM classification, the 5-year survival rate was stage IB, II, IIIA, and IV was 88.6%, 74.3%, 39.5%, and 33.3%, respectively. The metastatic lymph node ratio (nR) was divided into 4 categories; nR0 (76) = 0, 0 Classification ; Female ; Gastrectomy ; Humans ; Lymph Nodes* ; Male ; Neoplasm Metastasis ; Pathology ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate*

BACKGROUND: Metabolic syndrome is a major health problem in postmenopausal women, along with psychological issues. Hence, this study was conducted to investigate the relationship between metabolic syndrome and mental health properties targeting middle-aged menopausal women, and analyzed the psychological factors affecting the prevalence of metabolic syndrome. METHODS: The study subjects were 479 postmenopausal women aged 45-64 years, who had taken their routine health screenings from August to October in 2012. The presence of 3 or more of 5 risk factors constitutes diagnosis of metabolic syndrome. Depression, trait anxiety, and stress level were measured by Beck Depression Inventory, State-Trait Inventory, and Brief Encounter Psychological Instrument, respectively. Multiple logistic regression analysis was performed to confirm the relationship between the metabolic syndrome and psychological characteristics. RESULTS: The prevalence of metabolic syndrome in postmenopausal women was 16.5%. Metabolic syndrome was significantly related with trait anxiety (odds ratio [OR]=16.53, P=0.007) and depression (OR=0.16, P=0.012), after adjusting for age, marital status, educational level, monthly income, body mass index, eating habits and exercise. CONCLUSIONS: Trait anxiety and depression were found to be related with the prevalence of metabolic syndrome in postmenopausal women.
Anxiety ; Body Mass Index ; Depression ; Diagnosis ; Eating ; Female ; Humans ; Logistic Models ; Marital Status ; Mass Screening ; Mental Health ; Metabolic Syndrome X ; Postmenopause ; Prevalence ; Psychology ; Risk Factors

PURPOSE: Surgeons are confronted frequently with the diagnostic and therapeutic challenges in the cases of acute appendicitis in the elderly. Despite the improvements in management, the morbidity and mortality remain high. In order to verify contributing factors of high morbidity and mortality and establish more proper diagnostic and therapeutic strategies, we compared the clinical characteristics and outcomes of acute appendicitis in the elderly with those of younger people. METHODS: We retrospectively reviewed medical records of 30 elderly and 248 younger people who were pathologically diagnosed as appendicitis after an appendectomy. RESULTS: There was no difference in the rates of occurrence of right lower abdominal pain and tenderness between the two people. The rate of appendiceal perforation was significantly higher in the elderly. Prehospital delay was significantly longer in the elderly. Concomitant diseases were more prevalent in the elderly. The hospital stay was significantly longer and the rate of complication was relatively higher in the elderly also. CONCLUSIONS: When a vague and unexplained abdominal discomfort occurs in the elderly, we should suspect and rule out acute appendicitis as the cause of the discomfort. Early aggressive diagnostic and therapeutic interventions are essential components in managing acute appendicitis in the elderly. In addition, perioperative evaluation and prophylactic measures for concomitant diseases are needed to decrease morbidity and mortality in the elderly.
Abdomen, Acute ; Abdominal Pain ; Aged* ; Appendectomy ; Appendicitis* ; Humans ; Length of Stay ; Medical Records ; Mortality ; Retrospective Studies

OBJECTIVE: The purpose of this study was to investigate psychological impacts of infertility-related stress in Korean infertile women. METHODS: Both the 34 infertile women group and the control group(34 married women) were evaluated by using Semistructured Questionnaire, Stress Perception Scale, Coping Behavior checklist, Beck Depression Inventory(BDI), Hamilton Anxiety Scale(HAS), Hamilton Rating Scale for Depression(HRSD), SCL-90-R and State Trait Anxiety Inventory(STAI). RESULTS: Perceived financial stress, frequency of negative and neutral life events and frequency of passive coping(especially, emotion-focused coping) were significantly higher in infertile women than control group. In infertile women, totally perceived stress was positively correlated with BDI, SCL-90-R(depression) and STAI. Passive coping behavior was positively correlated with BDI, HAS and STAI. CONCLUSION: Above results suggest that infertile women would have a tendency to passive coping and high level of depression and anxiety, and should be considered for psychiatric intervention.
Adaptation, Psychological* ; Anxiety* ; Checklist ; Depression* ; Female ; Humans ; Surveys and Questionnaires

The possibility of a large quantity of information outflow has been growing since patients' private and medical information is being transmitted to inside and outside of the hospital because of the country's medical record computerization system. Accordingly, it has been threatening patient's privacy and the duty of confidentiality of medical people, and the introduction of security policy is needed which is required for patient information protection. We evaluated medical treatment facilities of diagnostic information security management by conducting questionnaire survey of medical documentation office about their standard of medical information security management, range of medical information access sanction to inside users, outside users' request for information and it's purpose. In the data of medical information user identification and authentication, about the grant of the ID and Password to official in charge, "All have it" has the most high percentaged as 60.0%, "Officer who's most needful have it" is the second as 15.7%, "one's post share it" is the third as 12.9%, but treatment facilities all show similar distribution. About the request for information by patients, All medical institution opened the information on occasion that patients themselves visited the institute and asked information, but in case of telephone inquiry, the only score 0.08 of the institutes accepted. This research, I hope, could be utilized for basic materials for medical recorder who control medical information to manage medical information security and to evaluate operation, and for individual hospital to manage the bound of opening to public and authority to access considering specificity of medical information, and supervisor. Also, the Goverment should set up a definite legal support about the political and technological plan to protect private information in the medical record.
Academies and Institutes ; Computer Security ; Confidentiality ; Financing, Organized ; Hope ; Humans ; Medical Records ; Privacy ; Surveys and Questionnaires ; Sensitivity and Specificity ; Telephone

BACKGROUND AND OBJECTIVES: Despite relatively high incidences of follicular variant of papillary thyroid carcinoma (FV-PTC), there is a continuous debate regarding the clinical behavior, treatment outcome, prognostic variables and survival of this disease. We performed this study for the purpose of getting further understanding and more supporting ideas for the treatment of FV-PTC. SUBJECTS AND METHOD: A clinicopathologic analysis of 116 patients who underwent a thyroidectomy with a final diagnosis of FV-PTC divided the patients into three groups: the FV-PTC only group (group A, n=78), the FV-PTC group who developed classical papillary thyroid carcinoma (C-PTC) (group B, n=38) and the C-PTC only (group C, n=320, 2003, Korea Cancer Center Hospital). The three groups were compared with respect to the following various clinicopathological characteristics: age at diagnosis, tumor size, stage of tumor, capsular invasion, age, metastasis, extent, size score, multifocality of tumor, LN metastasis, treatment, and recurrence. RESULTS: The mean tumor sizes, disease stage, and type of initial surgery were similar in three groups. However, the prevalence of nodal disease and capsular invasion were significantly higher in the groups B and C compared to the patients of group A. The 8-year disease-free survival rate was 93.7% in the patients with FV-PTC only, 90.4% in the patients with C-PTC only and 88.2% in the patients with FV-PTC group, who developed C-PTC (p>0.05). CONCLUSION: The clinical behavior and prognosis of PTC and FV-PTC groups did not differ significantly. In treating FV-PTC, we find that it is desirable to choose a similar strategy as that used to treat C-PTC.
Carcinoma ; Disease-Free Survival ; Factor IX ; Humans ; Incidence ; Korea ; Neoplasm Metastasis ; Prevalence ; Prognosis ; Recurrence ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Treatment Outcome

BACKGROUND: Intravenous administration of midazolam is widely used as a premedication for esophagogastroduonenoscopy. However, there are individual differences in midazolam doses for premedication and controversies for starting point of esophagogastroduonenoscopy after midazolam injection. There are also controversies for flumazenil injection time after esophagogastroduonenoscopy. The aims of this study were to determine the proper doses of midazolam for esophagogastroduonenoscopy and factors which affect midazolam doses. Also we evaluated the proper timing of flumazenil injection to increase patient's satisfaction according to sedation status. METHODS: 126 patients who were supposed to be taken diagnostic esophagogastroduonenoscopic exam were enrolled in this study. We evaluated the difference of patient's age, sex, alcohol consumption, sedation score, cooperation score, and satisfaction score according to midazolam doses. The relation between midazolam doses and agitation score, insomnia score, and somatic preoccupation score were checked. We evaluated the relation between midazolam doses and age, sex, alcohol consumption, amnesia, sedation, cooperation and satisfaction. RESULTS: There were no relationship between age, sex and midazolam doses. Alcoholics needed larger amount of midazolam than non-alcoholics. No differences in satisfaction were observed according to sedation status. There were significant relationship between midazolam doses and sedation score but not with satisfaction, cooperation, amnesia, agitation, insomnia and somatic preoccupation score. Patients who were injected flumazenil 20 minutes after esophagogastroduonenoscopy were more satisfied than patients who were injected flumazenil immediately after esophagogastroduonenoscopy. CONCLUSION: Minimal doses of midazolam that could induce mild sedation was enough and safe. Flumazenil injection 20 minutes after esophagogastroduonenoscopy was more efficacious than immediate injection.
Administration, Intravenous ; Alcohol Drinking ; Alcoholics ; Amnesia ; Conscious Sedation ; Dihydroergotamine ; Endoscopy, Digestive System* ; Flumazenil* ; Humans ; Individuality ; Midazolam* ; Premedication ; Sleep Initiation and Maintenance Disorders

Achalasia can be provoked by organic causes, and it is called secondary achalasia. Sometimes it is very difficult to distingush secondary achalasia from primary achalasia. We report a case of secondary achalasia due to recurrence of stomach cancer. A 45-year-old man came to our hospital due to three months history of dysphagia and regurgitation. Barium esophagogram showed concentric narrowing at the distal esophagus and dilatation of proximal esophagus. The esophagogastroduodenoscopy showed stenosis of gastroesophageal junction and the endoscope could not pass through it, but there was no evidence of malignancy. Esophageal manometry showed aperistalsis, compatible with achalasia. Abdominal CT showed soft tissue density near the gastroesophageal junction. However it was not possible to differentiate whether it was due to adhesion or malignancy. For correct diagnosis and treatment, explorolaparotomy was performed and it was diagnosed as secondary achalasia due to recurrence of stomach cancer.
Barium ; Constriction, Pathologic ; Deglutition Disorders ; Diagnosis ; Dilatation ; Endoscopes ; Endoscopy, Digestive System ; Esophageal Achalasia* ; Esophagogastric Junction ; Esophagus ; Humans ; Manometry ; Middle Aged ; Recurrence* ; Stomach Neoplasms* ; Stomach* ; Tomography, X-Ray Computed