No abstract available.
Rectal Prolapse* ; Surgical Procedures, Operative*

BACKGROUND: Surgical correction of the full spectrum of esophageal atresia with tracheoesophageal fistula has improved over the years, but the mortality and morbidity assoiated with repair of these anomalies still remains high. MATERIAL AND METHOD: We retrospectively analyzes 27 surgically treated patients with esophageal atresia and tracheoesophageal fistula at Dong-A University Hospital between January 1992 and March 1997. RESULT: There were 21 male and 6 female patients. Mean birth weight was 2.62+/-.385 kg(2.0~3.4 kg). Twenty- four(88.9%) had esophageal atresia with distal tracheoesophageal fistula, and 3(11.1%) had pure esophageal atresia. Four(14.8%) infants were allocated to Waterston risk group A, 18(66.7%) to group B, and 5(18.5%) to group C. In eighteen(66.7%) infants with associated anomalies, cardiovascular anomalies were the most common. Three had a gap length of 3.5 cm or greater(ultra-long gap) between esophageal segments, 7 had 2.0 to 3.5 cm(long gap), 8 had 1.0 to 2.0 cm(medium gap), and 9 had 1 cm or less(short gap) gap length. Among 27 neonates, 3 cases underwent staged operation, late colon interposition was done in 2, and all other 24 cases underwent primary esophageal anastomosis. Oerative mortality was 2/27(7.4%). Causes of death included acute renal failure(n=1), empyema from anastomotic leak(n=1), necrotizing enterocolitis(n=1), sepsis(n=1), insulin-dependent diabetus mellitus(n=1 . There were 4 anastomosis- related complications including stricture in 3, leakage in 1. Mortality was related to the gap length(p<.05). CONCLUSION: Although the complication rate associated with surgical repair of these anomalies is high, this does not always implicate the operative mortality. The overall survival can be improved by effective treatment for combined anomalies and intensive postoperatve care.
Birth Weight ; Cause of Death ; Colon ; Constriction, Pathologic ; Empyema ; Esophageal Atresia* ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Mortality ; Retrospective Studies ; Tracheoesophageal Fistula

BACKGROUND: Incidence of traumatic hip dislocation have ween increased with development of transportation. Traumatic hip dislocation demands early recognition as an emergency and prompt reduction. So we designed this study to determine what kinds of factors affect the prognosis of the patient. METHODS: Eighty five patients who admitted emergency department of our hospital with the traumatic hip dislocation were enrolled in this study. Cause of injury, type of dislocation, method of reduction, the time from dislocation to reduction, age, gender and associated patellar injury were evaluated by retrospective chart reviews. RESULTS: Average age of excellent and good group(E&G) is 28+/-17.8 and fair and poor group(F&P) is 39+/-18.6, so the older the age the more poor prognosis(P<0.05). The time to take reduction of E&G group is 18+/-8.2 hours and F&P group is 25+/-12.6 hours, so the faster the better prognosis(P<0.05). We classify the type of hip dislocation by Thompson and Epstein method, type I to type V. The prognosis of type I is better than type V(P<0.05). Fifty five case were associated with patellar injury and they had poor prognosis than the other cases that were not associated with knee joint injury. CONCLUSION: In traumatic dislocated hip patients, the prognosis was poor in old age, delay in reduction, higher type of dislocation and associated with knee joint injury.
Dislocations ; Emergencies ; Emergency Service, Hospital ; Hip Dislocation* ; Hip* ; Humans ; Incidence ; Knee Joint ; Prognosis* ; Retrospective Studies ; Transportation

BACKGROUND: The differentiation between hemorrhagic(HS) and norhemorrhagic(NHS) stroke is the most important first step in the management of acute stroke because clinical management of the two disorders differs substantially. Neuroimaging studies are useful in diagnosing and distinctioning between HS and NHS. The use of clinical variables, such as Siriraj stroke scores(SSS), has led to good sensitivity, specificity and predictive values. The aim of our study was to evaluate the use of the SSS in the Korean population and assess whether it could aid to expedite treatment decisions. METHODS: We reviewed 111 cases of stroke patients admitted to our hospital via the emergency department over a 6 months period from July to December 1998. Levels of consciousness, vomiting, headache, and atheroma markers used in the SSS were applied to these patients who met the criteria for a stroke. RESULTS: Of the 111 patients, the SSS classified 83 with sensitivities of 81.1%(NHS) and 73.3%(HS) and positive predictive values of 84.3% and 68.8%, respectively. The overall accuracy rate was 78.3%. CONCLUSION: Our results suggest that the SSS is not reliable in distinguishing stroke types in the Korean population. Definite neuroimaging studies are needed prior to thrombolytic therapy.
Consciousness ; Emergency Service, Hospital ; Headache ; Humans ; Neuroimaging ; Plaque, Atherosclerotic ; Sensitivity and Specificity ; Stroke* ; Thrombolytic Therapy ; Vomiting

Aneurysms of the coronary arteries are rare. They may be due to atheroselerosis, mucocutaneous lymph node syndrome, mycotic emboli, syphilis or trauma and occasionally they are congenital. The prognosis appears to be poor and death can occur suddenly from rupture of the aneurysm, peripheral coronary embolism or bacterial endocarditis. Recently surgical treatment has been successful. In a 5 year old patient with ventricular septal defect, two aneurysmal sacs located at the cardiac crux and just posterior to it was proved by coronary angiography and MRI, and successfully excised at operation.
Aneurysm* ; Child, Preschool ; Coronary Angiography ; Coronary Vessels* ; Embolism ; Endocarditis, Bacterial ; Heart Septal Defects, Ventricular ; Humans ; Magnetic Resonance Imaging ; Mucocutaneous Lymph Node Syndrome ; Prognosis ; Rupture ; Syphilis

BACKGROUND: It is well known that intracoronary thrombolysis during the early period of acute myocardial infarction leads to the limitation of myocardial necrosis, preserves left ventricular function, and improves survivals. The recanalization rate of intracoronary rrokinase infusion into infarct-related coronary artery was known as 62-94 percents in previos studies. The various factors influence the outcome of intracoronary thrombolysis, including total dose of urokinase, time from onsrt of chest pain to thrombolysis. The purpose of this study was to evaluate whether the occlusion site morphology influences recanalization rates of intracoronary thrombolysis. METHODS: We evaluated infarct-related coronary artery morphology of 56 acute mycardial infarction patients who performed intracoronary thrombolytic therapy within 6-12 hours after the onset of acute myocardial infarction. Intracoronary urokinase infusion was performed at a rate of 25000 IU/minute. The presence of calcification, collaterals, side branches and the stump site morphologies(thrombus type, pencil type, cutting type) were identified on magnified 35mm cine frames. RESULTS: Reperfusion was successed in 34 patients and failed in 22 patients. There were no statistically significant difference in the pressure of calcification, collaterals, and side branches between success and failure groups. Intracoronary thrombus was identified in 21 percent of success group, but not in failure group. The reperfusion rates according to stump site morphology were 76% in thrombus type, 58% in cutting type, and 42% in pencil type(p<0.05). CONCLUSION: Our study indicates the presence of intracoronary thrombus and the morphology of thrombus type is more effective in intracoronary thrombolysis in acute myocardial infarction. The identification of types of the coronary obstruction will be helpful for the selection of intracoronary thrombolysis in acute myocardial infarction patients. And the results suggest that the difference of stump composition show different stump morphologies.
Chest Pain ; Coronary Vessels* ; Humans ; Infarction ; Myocardial Infarction* ; Necrosis ; Reperfusion ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Ventricular Function, Left

PURPOSE: This study investigates the factors affecting spirituality in nursing students. METHODS: A total of 247 nursing students participated in the study. Data were analyzed by frequencies, t-tests, ANOVA, Pearson correlation coefficients and multiple stepwise regression via SPSS WIN 18.0. RESULTS: The mean scores for hope, gratitude, and spirituality were above-average. However, there were significant mean differences in spirituality according to religion, religious activity, voluntary service, satisfaction with the nursing field, and motivation for entering a college of nursing. Spirituality positively correlated with hope and gratitude. Significant predictors of spirituality included hope, gratitude, voluntary service and religious activity. The regression model explained 51.3% of perceived spirituality. CONCLUSION: To improve spirituality among nursing students, nursing educators should develop educational intervention programs to promote hope and gratitude, and support participation in voluntary service and religious activity.
Hope* ; Humans ; Motivation ; Nursing ; Spirituality* ; Students, Nursing*

Candidiasis is the most common fungal infection complicating the course of patients with hematologic malignant neoplasms. Although widespread organ involvement is characteristic of disseminated candidiasis, reports of skin are rare. Reports describing typical clinical and histopathological finding of cutaneous lesions are very important since it may enable a diagnosis of disseminated candidiasis to be made and thus antifungal therapy can be initiated earlier. A 50-year-old housewife was admitted with a 5-month history of fatigue and easy bruising. She was diagnosed as ha.ving acute myelocytic leukemia and treatment was begun with daunorubicin and cytosin, arabinoside. Eight days after the start of chemotherapy, she developed a fever and generalized tender well demacated erythematous to purplish papulonodular eruption. A biopsy specimen from the skin lesion showed perivascular mononuclear cell infiltration and spore and pseudohypae v,rere found within the dermis and subcutis in PAS stain. Cultures of one skin biopsy specimen and one of four blood sarnples grew Candida tropicalis. The patient was treated with intravenous amphotericin B for disseminated candidiasis. On the tenth day of antifun gal therapy, she developed cardiopulmonary arrest and died.
Amphotericin B ; Biopsy ; Candida tropicalis ; Candidiasis* ; Daunorubicin ; Dermis ; Diagnosis ; Drug Therapy ; Fatigue ; Fever ; Heart Arrest ; Humans ; Leukemia, Myeloid, Acute ; Middle Aged ; Skin Manifestations* ; Skin* ; Spores

Bottoming out is the term used to describe the inferior displacement of a breast implant after breast augmentation that results in increased distance between the nipple areolar complex and the inframammary fold. Conventional techniques for correcting bottoming out involve capsulectomy and capsulorrhaphy via an inframammary fold incision that is prone to cause large scar and increases the patient's burden. However, using an endoscopic approach via the axilla, we are able to correct bottoming out, resulting in a smaller scar and shorter recovery time. In this article, we present a novel and simple method to correct bottoming out using endoscopy and electrocauterization.
Axilla ; Breast Implants ; Breast* ; Cicatrix ; Endoscopy ; Nipples

Bilateral coronary artery fistula is very uncommon congenital anomaly which occupy small percentage of all congenital coronary artery fistula. About 20% of the cases associated with additional congenital heart disease. And it may cause congestive heart failure, especially severely in neonate. We experienced a case of neonate who was 1 day-old-male with bilateral coronary artery-right ventricular fistula associated with atrial septal defect and congestive heart failure. The Patient was admitted because dyspnea, cyanosis since birth. 2D ecgicardiogram and cardiac catheterization revealed that a fistulous communicating ; forming a large aneurysm, was noted from bilateral coronary artery emptied into the right ventricle, and there was oxygen step-up in right ventricle.
Aneurysm ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Vessels ; Cyanosis ; Dyspnea ; Fistula* ; Heart Defects, Congenital ; Heart Failure ; Heart Septal Defects, Atrial* ; Heart Ventricles ; Humans ; Infant, Newborn* ; Oxygen ; Parturition