A clinical analysis was performed on 326 cases of the non-penetrating rib fractures experienced in the department of thoracic and cardiovascular surgery, Chosun University Hospital and 102 cases of the non-penetrating rib fractures those has been admitted and treated in the department of thoracic and cardiovascular surgery, Jeonnam Hwasoon Jung-ang Hospital during a period from Jan. 1994 to Dec. 1995. 1. Sex ratio was 3.4:1 in urban and 3.6:1 in rural communities with male predominance. 2. Most common cause were traffic accident in both communities. 3. Hemothorax, pneumothorax and hemopneumothorax which needed thoracostomy were observed in 146 cases(44.7%) in the urban and 12 cases(11.7%) in the rural communities. 4. Left thorax was the spell site of rib fractures in both communities. 5. Rib fracture was prevalent from 3rd to 6th rib in both communities. 6. Open thoracotomy was performed in 37 cases(11.3%) in urban and 3 cases(2.9%) in rural communities. 7. Overall mortality was 4.29%(14 cases) in urban area and, 1.96%(2 cases) in rural communities, and cause of death were hypovolemic shock, brain edema, sepsis, respiratory failure, asphyxia, and cardiogenic shock.
Accidents, Traffic ; Asphyxia ; Brain Edema ; Cause of Death ; Hemopneumothorax ; Hemothorax ; Humans ; Jeollanam-do ; Male ; Mortality ; Pneumothorax ; Respiratory Insufficiency ; Rib Fractures* ; Ribs* ; Rural Population* ; Sepsis ; Sex Ratio ; Shock ; Shock, Cardiogenic ; Thoracostomy ; Thoracotomy ; Thorax

BACKGROUND: Unlike its use during stable conditions, central venous pressure (CVP) monitoring from a peripherally inserted central venous catheter (PICC) has not often been used in surgeries with significant hemodynamic alterations. The aim of this study was to evaluate the feasibility of measuring PICC pressure (PICCP) as an alternative to measuring centrally inserted central catheter pressure (CICCP) in adult liver transplantation (LT) patients. METHODS: We measured PICCP and CICCP simultaneously during each main surgical period in adult LT. Statistical analysis was performed using simple linear regression analysis to observe whether changes in PICCP paralleled by simultaneous changes in CICCP. Correlation analysis and Bland-Altman analysis were used to determine the degree of agreement between the two devices. Differences were considered statistically significant when P values were less than 0.05. RESULTS: A total of 1342 data pairs were collected from 35 patients. The PICCPs and CICCPs were highly correlated overall (r = 0.970, P < 0.001) as well as at each period measured. The differences among each period were not clinically significant (0.33 mmHg for pre-anhepatic, 0.32 mmHg for anhepatic, -0.15 mmHg for reperfusion, and -0.10 mmHg for neohepatic periods). The overall mean difference was 0.14 mmHg (95% confidence interval: 0.09-0.19) and PICCP tended to give a higher reading by between 0.09 and 0.19 mmHg overall. The limit of agreement was -1.74 to 2.02 overall. CONCLUSIONS: These findings suggest that PICCP can be a reasonable alternative to CICCP in situations of dynamic systemic compliance and preload, as well as under stable hemodynamic conditions.
Adult ; Catheters ; Central Venous Catheters ; Central Venous Pressure ; Compliance ; Hemodynamics ; Humans ; Jugular Veins ; Linear Models ; Liver ; Liver Transplantation ; Reperfusion

PURPOSE: The purpose of this study was to identify students' experiences of performance and their satisfaction with clinical nursing practice in Women's health nursing. METHODS: Data was collected using questionnaire consisting of 104; 89,; and 82 nursing activities with 12; 10; and 7 domains for delivery floor, obstetric, and gynecologic wards retrospectively. Five hundred ninety nursing students from 10 four year and one three year colleges, were recruited and selected for data collection. RESULTS: Site specific core nursing activities among top 15 items of performed experience were: interpreting fetal monitoring; massage for pain reduction; breathing technique; perineal pad change; non stress test; manual check for uterine contraction; and position change for the delivery floor. Experiences of clinical nursing practice for the obstetric ward and the gynecologic ward were identified and ranked as well. Observation of delivery, measurement & test during labor and observation of anesthesia and operation were the highest ranked activity domains of satisfaction for delivery floor, obstetric and gynecologic wards retrospectively. CONCLUSION: Discussions are needed to standardize curriculum for clinical practice in women's health nursing initiated at the level of Korean Society of Womens' Health Nursing by reflecting this result. Strategic approaches are emphasized in order to enhance a collaboration between clinical fields and colleges.
Anesthesia ; Cooperative Behavior ; Curriculum ; Floors and Floorcoverings ; Humans ; Massage ; Surveys and Questionnaires ; Respiration ; Retrospective Studies ; Students, Nursing ; Women's Health

OBJECTIVE: Suprasellar meningioma have in general been difficult lesions to treat because of their vicinity to the optic apparatus and major vessels, and high vascularity. This study was performed to analyze clinical outcome of patients with histopathologically identified suprasellar meningioma. METHOD: Between 1989 and 1998, 37 patients(30 women, 7 men: average 47.5years) with histopathologically identified meningiomas originating from the suprasellar region underwent surgical tumor removal in our institution. The medical records and clinical data of these patients are retrospectively analyzed. RESULT: The tumor size ranged from 2.1cm to 6.5cm(average 5.1cm) in diameter. The tumors have been approached basically through the pterional and bifrontal routes. Skull base technique was also applied in large or complicated cases. Total resection rates and overall outcome including visual function was better in patients with tumor of less then 3cm. A considerable increase of mortality, morbidity and failure of visual improvement were seen in case of the tumors size of 3cm or more. CONCLUSION: Early diagnosis and treatment were important factors in the successful management of these suprasellar meningioma. In large complicated cases encasing major vessels or invading cavernous sinus or anterior skull base, surgeons need to operate with extreme caution and piecemeal removal of the tumor without injuring optic apparatus and major vessels utilizing skull base technique.
Cavernous Sinus ; Early Diagnosis ; Female ; Humans ; Male ; Medical Records ; Meningioma* ; Mortality ; Retrospective Studies ; Skull Base

OBJECTIVE: We analysed various surgical approaches and surgical results of 28 middle cranial base tumors for the purpose of selecting optimal surgical approach to the middle cranial base tumor. METHODS: In this retrospective review, 28 patients, including 16 meningioma, 6 trigeminal neurinoma, 2 pituitary adenoma, 2 craniopharyngioma, 1 facial neurinoma, and 1 metastatic tumor, underwent surgical treatment using skull base technique. Of theses, 16 tumors were mainly confined to middle cranial fossae, 5 tumors with extension into both anterior and middle fossa, and 7 tumors with extension into both middle and posterior fossa. Tumors that confined to the middle cranial fossa or extended into the anterior cranial fossa were operated with modified pterional, orbitozygomatic or Dolen'c approach, and tumors that extended into the posterior cranial fossa were operated with anterior, posterior or combined transpetrosal approach. Completeness of tumor resection, surgical outcome, postoperative complication, and follow up result were studied. RESULTS: Total tumor removal was achieved in 9 tumors of 10 tumors that did not extended to the cavernous sinus, and was achieved in 7 tumors of 8 tumors that extended to the lateral wall of the cavernous sinus. Of 10 tumors that extended to the venous channel of the cavernous sinus, only 2 were removed totally. Surgical outcome was excellent in 14 patients, good in 10, fair in 2 and poor in 2. There were no death in this series. Dumbell type tumor which extended into both middle and posterior fossae showed tendency of poor prognosis as compared with tumors that confined middle cranial fossa and extended into both anterior and middle cranial fossa. Postoperative dysfunctions were trieminal hypesthesia in 3, oculomotor nerve palsy in 2, abducens nerve palsy in 2, hemiparesis in 2, cerebellar sign in 1, facial palsy in 1 and hearing impairment in 1. CONCLUSION: Based on our findings and a review of the literature, we conclude that, when selecting the surgical approach to the middle cranial fossa tumors, the most important factors to be considered were exact location of the tumor mass and existence of the cavernous sinus invasion by tumor mass. We recommend modified pterional or orbitozygomatic approach in cases with tumors located anterior and middle cranial base, without cavernous sinus invasion. In cases with tumors invading into cavernous sinus, we recommend Dolen'c or orbitozygomatic approach. And in lateral wall mass and the cavernous sinus, it is preferred to approach the tumor extradurally. For the tumor involing with middle fossa and posterior fossa(dumbell type) a combined petrosal approach is necessary. In cases with cavernous sinus invasion and internal carotid artery encasement, we recommend subtotal resection of the tumor and radiation therapy to prevent permanent postoperative sequele.
Abducens Nerve Diseases ; Carotid Artery, Internal ; Cavernous Sinus ; Cranial Fossa, Anterior ; Cranial Fossa, Middle ; Cranial Fossa, Posterior ; Craniopharyngioma ; Facial Paralysis ; Follow-Up Studies ; Hearing Loss ; Humans ; Hypesthesia ; Meningioma ; Neurilemmoma ; Oculomotor Nerve Diseases ; Paresis ; Pituitary Neoplasms ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Skull Base*

BACKGROUND: Depletion of nutritional reserves and significant weight loss can lead to an increased risk of morbidity, reduced chemotherapy response, and shorter survival in patients with cancer. Numerous methodologies are used for the assessment of nutritional status. However, it remains unclear which of these tools is the most appropriate in the setting of cancer chemotherapy. The PINI (prognostic inflammatory nutritional index) is a simple scoring system that has been used to evaluate nutritional status and prognosis in critically ill patients. The aim of this study was designed to investigate the relationship between nutritional status after the palliative chemotherapy and prognosis in advanced metastatic cancer. METHODS: This study included 130 patients with ECOG PS (Eastern Cooperative Oncology Group performance status) 1~3 in advanced metastatic cancer following the palliative chemotherapy. ECOG PS, body mass index, alpha 1-acid glycoprotein, C-reactive protein, albumin, prealbumin, transferrin, protein, lactate dehydrogenase, PINI ratio, and survival time were evaluated. RESULTS: In 130 patients, the median age was 57 years. The ECOG PS was 1 68 patients, 2 43, 3 19. The mean value of PINI was PS 1 16.0+/-47.8, PS 2 55.6+/-106.9, PS 3 106.3+/-141.6. The mean survival was PS 1 144.0+/-71.8, PS 2 68.9+/-41.2, PS 3 32.0+/-6.9 days. In the PS 3 group, the mean values of alpha 1-acid glycoprotein, C-reactive protein, and lactate dehydrogenase were significantly higher than in the PS 1 group. In the PS 3 group, the mean values of albumin, prealbumin, and transferrin were significantly lower than in the PS 1 group. The survival time was correlated with the ECOG PS (r=-0.602, p<0.001,), PINI (r=-0.318, p<0.001,), alpha 1-acid glycoprotein (r=-0.265, p=0.002), C-reactive protein (r=-0.345, p<0.001), albumin (r=0.324, p<0.001), prealbumin (r=0.260, p=0.003) and transferrin (r=0.277, p=0.001). CONCLUSIONS: The PINI may be a useful scoring system for the assessment of nutritional status and prognosis in advanced metastatic cancer following palliative chemotherapy, but the ECOG PS is most strong correlation with the survival time.
Body Mass Index ; C-Reactive Protein ; Critical Illness ; Drug Therapy ; Humans ; L-Lactate Dehydrogenase ; Nutrition Assessment ; Nutritional Status* ; Orosomucoid ; Prealbumin ; Prognosis* ; Transferrin ; Weight Loss

The aim of this study was to assess the nutrient intakes of the elderly subjects in Korea. Dietary assessment was carried out using a semi-quantitative food frequency questionnaire (SQFFQ) developed by our laboratory, which included 98 commonly consumed food items selected from 1998 National Health and Nutritional Survey for Korean population. Subjects (n = 2,660) aged 50yr and over were recruited in Seoul, 6 metropolitan cities, and 8 mid-size cities. Calcium and riboflavin intakes of the elderly subjects aged 65 yr and over (n = 1,974) were much lower compared with Korean RDA. Nutrient intakes of the three age group (50-64 yr, 65-74 yr, 75 yr and over) were decreased as age increased in male and female elderly. Nutrient intakes of male elderly, 75 yr and over, were significantly decreased while in female elderly nutrient intakes were gradually decreased as age increased. Over 30% of the elderly subjects did not meet 75% RDA for calcium, iron, vitamin A, and riboflavin. The proportion of the elderly subjects whose intakes were below 75% RDA was much higher than the elderly whose intakes were above 125% RDA, especially among the elderly aged 75 yr and over. This study revealed that the Korean elderly had inadequate intakes for many nutrients. This will cause a serious nutritional problem for the elderly.
Aged* ; Calcium ; Female ; Humans ; Iron ; Korea ; Male ; Nutrition Surveys ; Riboflavin ; Seoul ; Vitamin A ; Surveys and Questionnaires

The purpose of this study was to develop a semi-quantitative food frequency questionnaire (SQ-FFQ) for subjects aged 50yr and over and to evaluate the validity of this SQ-FFQ. Dietary intake was assessed using SQ-FFQ that included 98 commonly consumed flood items selected from the results of the Korean Health and Nutritional Survey, 1998. Subjects (n = 2,660) aged 50yr and over were recruited from 7 metropolitan cities and 8 small cities. Each subject was interviewed using this SQ-FFQ developed in our laboratory and 24hr-recall method. Excluding incomplete data, Data from 1,149 subjects were used in this validity study. The nutrient intakes assessed by this SQ-FFQ were validated by comparing with the results from 1 day 24-hour recalls. Pearson's correlation coefficients between two methods were 0.71, 0.64, 0.53, and 0.43 for energy, carbohydrate, protein, and fat, respectively for all subjects. Spearman's correlation coefficients were higher than those of Pearson's correlation coefficients. Kappa values for energy, carbohydrate, protein, and fat were 0.79, 0.72, 0.70, and 0.64, respectively. The percentage for misclassification of the lowest quartile into the highest quartile or vice versa was 1.25-1.39% for all nutrients. Therefore, this SQ-FFQ seems to be useful in assessing the nutritional status of the middle-aged and elderly subjects in Korea.
Aged* ; Humans ; Korea ; Nutrition Surveys ; Nutritional Status* ; Surveys and Questionnaires

BACKGROUND: The presence of axillary lymph node metastases (ALNM) and tumor size are two most important prognostic factors in breast cancer. An axillary lymph node dissection (ALND) is usually performed in infiltrating breast cancer for the information of therapeutic decision and prediction of prognosis. However this procedure results in lymphedema of the affected upper extremity, increased axillary drainage, sensory abnormality, and pain. If the axillary lymph node status could be predicted accurately prior to an ALND, selected patients with a low probability of ALNM could be spared the procedure. The purpose of this study was to determine the association between the incidence of ALNM and 14 clinico-pathologic factors by using univariate and multivariate analysis and to investigate the possibility of using those factors as predictors for ALNM. METHODS: We reviewed data from 253 patients with breast cancer who had undergone at least a level I/II axillary dissection between 1991 and 1998. The association between the incidence of ALNM and 14 clinico-pathologic factors (age, menstruation, tumor size, palpability of tumor, tumor site, pathologic type, nuclear grade, estrogen receptor status, progesteron receptor status, p53, c-erbB-2, Ki67, Cd34, and Cathepsin D) were analyzed by using univariate and, when significant, multivariate analysis. RESULTS: Approximately 38.7% of the 253 patients with breast cancer had ALNM. Univariate analysis showed that ALNM were associated with tumor size (P<0.01), pathologic type (P<0.001), palpability (P<0.01), and nuclear grade (P<0.01). However, independent predictors of ALNM in the multivariate analysis were tumor size and pathologic type. Among the patients with smaller than 1.0 cm in the tumor size and DCIS in the pathologic type, the ALNM was not founded. CONCLUSIONS: We conclude that the characteristics of primary breast cancer can help assess the risk for ALNM. Selected patients, who are assessed to be minimal risk, might be spared a routine ALND, if the treatment decision would not be influenced by the lymph node status.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Cathepsins ; Drainage ; Estrogens ; Female ; Humans ; Incidence ; Lymph Node Excision ; Lymph Nodes* ; Lymphedema ; Menstruation ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis ; Upper Extremity

OBJECTIVE: The rupture of an aneurysm during operation is an event that can be considered grave. The authors present the retrospective analysis of 10 cases of intraoperative rupture in 145 consecutive aneurysm procedure. METHODS: Of 10 cases of intraoperative rupture, two cases were ruptured at predissection period, six cases during dissection and two cases during clip application. RESULTS: The causes of intraoperative aneurysm rupture in our 10 cases were forceful and blunt dissection(4 cases), excessive brain retraction(2 cases), poor exposure of aneurysm neck(1 case), poor clip application(1 case), excessive removal of aneurysmal intracerebral hematoma(1 case), unknown(1 case that was ruptured during anesthesia or craniotomy). Methods of management of nine intraoperative rupture except one of rupture during craniotomy were temporary clipping to the parent artery(3 cases), tentative aneurysm clipping(2 cases), temponade with cottonid and suction(2 cases), and induced hypotension(2 cases). The final outcome of 10 cases of intraoperative aneurysmal rupture was good in 5, fair in 1, poor in 1 and dead in 2 cases. Especially cases that were ruptured during predissection period and case that were managed with induced hypotension were poor result. CONCLUSION: The use of meticulous microsurgical technique with sharp dissection around the aneurysm, a systematic contingency plan for dealing with sudden hemorrhage and the judicious use of temporary clips should serve to minimize the adverse effect of intraoperative rupture on overall management morbidity and mortality.
Anesthesia ; Aneurysm* ; Brain ; Craniotomy ; Hemorrhage ; Humans ; Hypotension ; Mortality ; Parents ; Retrospective Studies ; Rupture*