Breast cancer is the second leading cause of cancer death in women. Unfortunately, the frequency of breast cancer and mastectomy are increasing in Korea. The purpose of the study is to analyze the results of breast reconstruction using free transverse rectus abdominis myocutaneous(TRAM) flap and to suggest the operative technique for more satisfactory results. 19 patients underwent immediate breast reconstruction from 1990 to 1998, and we experienced 2 cases of bilateral immediate reconstruction of breasts following mastectomy. We have performed the free TRAM flaps based on the deep inferior epigastric vessels using microvascular technique. TRAM flap included very small portion of rectus sheath and muscle-so called muscle sparing technique. So it reduced markedly donor site morbidity. The postoperative course of these cases was uneventful with minor complication. The free TRAM flap was an excellent method of immediate breast reconstruction using autogenous tissue and provided satisfactory outcome. The goals of the immediate breast reconstruction after mastectomy are to restore body image, to achieve near normal shape of breast, and to reduce the complications. This paper represents our experience of immediate breast reconstruction using free TRAM flap, and technical options to get more satisfactory result and reduce the complications. We think this method could be regarded as the first choice for immediate breast reconstruction.
Body Image ; Breast Neoplasms ; Breast* ; Female ; Humans ; Korea ; Mammaplasty* ; Mastectomy ; Rectus Abdominis* ; Tissue Donors

No abstract available.

No abstract available.
Hemorrhage*

No abstract available.
Pulmonary Atelectasis*

PURPOSE: This study aimed to investigate job satisfaction, organizational commitment and turnover intention among male nurses in South Korea. METHODS: Data were collected in May, 2013 and a total of 150 male hospital nurses participated in this study. Job satisfaction, organizational commitment and turnover intention were measured using a structured questionnaire. Collected data were analyzed using SPSS/WIN 20.0 for windows. RESULTS: There were statistically significant correlations between job satisfaction and organizational commitment (r=.74, p<.001), job satisfaction and turnover intention (r=-.56, p<.001), and organizational commitment and turnover intention (r=-.69, p< .001). There was a statistically significant difference in job satisfaction of participants according to education, work unit, and salary. Organizational commitment showed significant difference according to age, education, work unit, and salary. Turnover intention was significantly different according to duration of employment in the hospital, and salary. The most influential factor for turnover intention was organizational commitment (beta=-.69, p<.001). This factor accounted for 47.8% of the variance in turnover intention. CONCLUSION: The results of this study indicate that to reduce turnover intention for men in nursing, it is necessary to increase job satisfaction, and organizational commitment.
Education ; Employment ; Humans ; Intention* ; Job Satisfaction* ; Korea ; Male ; Nurses, Male* ; Nursing ; Surveys and Questionnaires ; Salaries and Fringe Benefits

PURPOSE: To describe the appearance and average thickness of the internal anal sphincter with anal endosonography in healthy Korean adults. MATERIAL AND METHODS: 184 subjects(male: 96, female: 88) with no history of anorectal disease or surgery were studied with anal endosonography. The average thickness of internal sphincter was meas ured at the mid-anal canal. For the internal sphincter, which is often asymmetric, the thickness of each 4 part(12, 3, 6 and 9 o'clock direction) were measured in left lateral decubitus position. RESULTS: The anal wall was well visualized in 5 layers(mucosa, submucosa, internal anal sphincter, intersphincteric plane, external anal sphincter) with anal endosonography. The anal endosonogram showed the internal anal sphincter as a homogenous, well-defined, hypoechoic, circular band, and slightly asymmetric. The average thickness of the internal anal sphincter in the area of mid-anal portion was 2.0 0.3 mm(range: 1~3 mm). There was no sexual difference; however, a significant positive correlation with age was found in average thickness of the internal anal sphincter. The correlation with lean body mass was not found. CONCLUSION: The internal anal sphincter is well-visualized, best defined structure by anal endosonography. Average thickeness of the sphincter in Korean appeared to be the same as in the Western.
Adult* ; Anal Canal* ; Endosonography ; Female ; Humans

Extensive laceration of the lung itself has relatively little attention as a threat to life compared with other intrathoracic organ injuries. The incidence of pulmonary laceration extensive enough to require thoracotomy is rare, but is higher than expected. The diagnosis of extensive pulmonary laceration may be difficult, but this injury should be suspected with attention and early thoracotomy can be carried out in indicated cases. Recently, thoracoscopy has assumed a major role in the management of a variety of surgical diseases of the chest. We experienced a case of extensive pulmonary laceration caused by nonpenetrating trauma, which underwent lobectomy by thoracoscopic surgery. A 21-year-old man who was injured in a motocycle accident was brought to Emergency Room from the scene by an ambulance, and complained of chest pain and dyspnea. A chest roentgenogram showed a hemothorax and fractures of the posterior ends of the right seventh, eighth, and ninth ribs. A chest tube was inserted. Thirteen hundred ml of blood was drained through the chest tube during the next one hour. Emergency right mini-thoracotomy revealed extensive laceration of the lower lobe extending to the pulmonary hilum. The lower lobe was the most badly torn. A lower lobectomy was done by video-assisted thoracic surgery (VATS). He complained less postoperative pain and the postoperative course was uneventful.
Ambulances ; Chest Pain ; Chest Tubes ; Diagnosis ; Dyspnea ; Emergencies ; Emergency Service, Hospital ; Hemothorax ; Humans ; Incidence ; Lacerations* ; Lung ; Pain, Postoperative ; Ribs ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy ; Thorax ; Young Adult

BACKGROUND AND OBJECTIVES: The change of voice quality on menstrual cycle is regarded as general in professionals. The primary objective of this study is to evaluate the changes of acoustic parameters during menstrual cycle in general population. METHODS: Twenty young adults were asked to produce vowel /a/, /i/ , and /u/ and to read book audibly at the proliferative phase of the menstrual cycle and premenstrual phase. And then, the sound of the voice in each case was recorded and analyzed by the Computerized Speech Lab. (CSL, Kay Elemetrics, Model 4300B, USA). The statistical analyses were performed using paired t-test to compare several variables of data. RESULTS: Compared with the acoustic parameters between two periods, there were no significant differences in all subjects. But the acoustic parameters with book-reading loudly during menstrual cycles revealed slight changes in voice quality. CONCLUSION: The change of voice quality, especially the fatigue of voice may be concerned with menstrual cycle, so more careful voice habituation was required during the menstrual period.
Acoustics ; Fatigue ; Female ; Humans ; Menstrual Cycle* ; Voice Quality* ; Voice* ; Young Adult

OBJECTIVE: To investigate the effect of extracorporeal shock wave therapy (ESWT) on pressure ulcers which is a major, functionally-limiting medical problem impairing quality of life for many people each year. METHOD: Seven patients who had stage 3 pressure ulcers were enrolled for the study. Each patient was treated with 6 sessions of low-energy (0.10~0.15 mJ/mm2, 1,000 impulses) ESWT. The length, width, depth and soft tissue biopsy of pressure ulcers were evaluated every 2 weeks for 6 weeks. RESULTS: The length, width and depth decreased significantly after 2 weeks of ESWT application. Healthy granulation tissue was formed. Soft tissue biopsy revealed increased the number and size of capillaries and decreased inflammatory cells in treated case. CONCLUSION: ESWT promoted wound healing and revealed favorable histological changes in pressure ulcers. We suggest that ESWT can be used for the safety and effective management of pressure ulcer.
Biopsy ; Capillaries ; Granulation Tissue ; Humans ; Pressure Ulcer ; Quality of Life ; Shock ; Wound Healing

p53 is a tumor suppressor gene product identified in a wide range of tumor including colorectal carcinoma. Genetic alterations in the p53 tumor suppressor gene are common in human colorectal carcinoma. bcl-2 is a protooncogene that inhibits apoptosis. The products of mutant p53 gene and bcl-2 have been associated with prognosis in several malignancies including colorectal carcinomas. This study was undertaken to evaluate values of p53 and bcl-2 oncoproteins as prognostic factors relative to clinicopathological factors and correlation of their expression. Analyses were made on achieval pathologic tissues of 80 patients with colorectal carcinomas including 34 patients able to follow-up over 5 years. The oncoproteins were localized using commercially available monoclonal antibodies:DO-7 for p53, clone124 for bcl-2. Expression of bcl-2 was cytoplasmic, whereas nuclear p53 expression was localized in carcinoma cells. The patients were 17 to 83 years of age. The expression of p53 and bcl-2 was determined respectively in 30 (37.5%) and 21 (26.3%)cases. The expression of p53 nuclear expression was not correlated with tumor location, size, histologic grade, Duke's classification, regional lymph node metastasis and tumor recurrence. The cytoplasmic expression of bcl-2 was not correlated with tumor location, size, histologic grade, Duke's classification, regional lymph node metastasis and recurrence. Univariate analysis showed that patients with p53 nuclear expression were not associated with poorer overall survival than patients with p53 negative, and also showed in patients with bcl-2 expression. The expression of p53 did not affect to that of bcl-2. We concluded that the p53 nuclear and bcl-2 cytoplasmic expression were not independent prognostic factors in colorectal carcinomas. Evidence of reciprocity of bcl-2 and p53 expression was not found.
Apoptosis ; Classification ; Colorectal Neoplasms* ; Cytoplasm ; Follow-Up Studies ; Genes, p53 ; Genes, Tumor Suppressor ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Oncogene Proteins ; Prognosis ; Recurrence