Intrinsic plus deformity, which results in severe functional impairment of the hand, is caused by contracture of intrinsic muscles. This deformity can be resulted from many causes such as ischemic damage, spasm of intrinsic muscles, thermal injury, and so on. The surgical release of tightened intrinsic muscles, may be the only solution to make usable hand, especially for severe cases. Sixty five digits in 22 patients who were operated on from 1982 to 1992, were evaluated retrospectively, to analyse the effects of surgery for intrinsic plus hand. Among 65 digits, 13 were thumbs and 52 fingers. The mean age of the patients was 26 years and 8 months and 17 cases were males and 6 females. The causes were ischemic damage by laceration or crushing injuries in 11 patients, compartment syndrome in 5, cerebral palsy in 5, and burn in one. Involved digits were thumb only in 4 patients, thumb and fingers in 9, and fingers in nine. All the digits were classified preoperatively by Zancolli's classification. In 13 thumbs retropulsion contracture was 4 and adduction-antepulsion contracture was nine. All of the thumbs were treated by intrinsic release and Z plasty(or rotational flap). Other procedures including arthrolysis, arthrodesis and tendon reconstruction were combined in 9 thumbs. In 52 fingers, in addition to distal release, arthrolysis was combined in 12 fingers, and arthrolysis plus volar plate release were combined in 4 fingers. For the assessment, our criteria, based on subjective satisfaction of the patient and range of motion, was used. The duration of follow up was from one year to 9 years with the average of 26 months. In 14 thumbs the results were excellent in 2, 6 good, 4 fair, and one poor. In 52 fingers excellent was 12, 24 good, 13 fair, and 3 poor. In summary we could improve the function of intrinsic plus deformity by appropriate sugery, and their results were good.
Arthrodesis ; Burns ; Cerebral Palsy ; Classification ; Compartment Syndromes ; Congenital Abnormalities ; Contracture ; Female ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Lacerations ; Male ; Muscles ; Range of Motion, Articular ; Retrospective Studies ; Spasm ; Tendons ; Thumb

No abstract available.
Autopsy* ; Hydrops Fetalis*

To achieve optimal decalcification in tissue and tissue preservation, we have tried magnetic field method and made some promising results. We used pulsed unipolar magnetic field obtained by rectification of 250 V-60 cycle, A.C. As a new method of bony decalcification, using 5% nitric acid, 10% formic acid and 10% formic acid+3% hydrochloric acid solutions, experimental groups were decalcified in the center of the magnetic field. The concentration of calcium ion in the decalcifying solution was measured by calcium-oxalate turbidity test by photometry method, and direct visualization of calcium radiopacity was obtained by soft X-ray view during the decalcification process. The pH change during decalcification was continuously checked and needle penetration method was also used. All the decalcification solution used in this study showed accelerated effect of bony decalcification in the strong magnetic field. Among them 5% nitric acid produced complete decalcification for the medium size bony specimen (less than 10x10x10 mm) within 24 hours, and the histologic feature was almost free of acid-chemical degeneration. The pH of all the decalcification solutions decreased in the strong magnetic field, maximum within 4~6 hours, and kept strong acidity throughout the decalcification procedure. After removal of the magnetic field the pH of all the decalcification solution returned to their original values after 24 hours. It was presumed that the cause of the accelerated decalcification in the magnetic field was due to combined effects of the rapid increase of acidity and the increased molecular resonance to stimulate the ionization of mineral elements.

PURPOSE: The purpose of this survey was to investigate clinical nurses' understanding of delirium and their educational need of delirious patient care. METHOD: A survey questionnaire regarding nurses' general perception and understanding of delirium, experience with delirious patients and educational need was developed and conducted with 179 clinical nurses in a university hospital in Seoul. Data was analyzed using descriptive statistics. RESULTS: Nurses thought that delirium was one of the most important nursing problems and they considered it to be more treatable than to be preventable. However, the majority of nurses were not confident in caring for delirious patients. Nurses reported that delirium happened most often after surgery, and that possible contributing factors could be changes in physical environment and anxiety/stress, as well as medication and long-term isolation. Thirteen nursing interventions were identified but half of the nurses utilized only one or two of the thirteen. The most frequently used intervention was reorienting the patient followed by medication and emotional support, presenting family, and close observation. 99.5% of nurses addressed the importance of professional education on delirium care, especially in the area of intervention and management. CONCLUSION: The results support the strong need for development of a multi-component educational program on delirium care.
Adult ; Delirium/*nursing/psychology ; Female ; Hospitals, University ; Humans ; Male ; Models, Nursing ; Nursing Staff, Hospital/education/*psychology ; Program Evaluation ; Qualitative Research ; Questionnaires

Segmentalization of spinal fixation enhances correction of the coronal plane deformity and allows preservation of normal sagittal contour offering rigid fixation. Purpose of this paper was to evaluate the efficacy and safety of segmental pedicle screw fixation in the treatment of idiopathic thoracic scoliosis. From 1987 to 1991, 78 idiopathic thoracic scoliosis patients were treated with CD instrumentation. Thirty-one were treated with hooks, 23 with pedicle screws inserted in hook pattern and 24 with segmental pedicle screws. In segmental screw group, the screws were inserted for every other on the convex side. After follow up of minimum 2 years(range:24 to 52 months), the results of coronal, sagittal and rotational correction were compared. Major curve correction was 55% with hooks, 66% with hook pattern screws and 72% with segmental screws, with loss of correction of 6%, 2% and 1% respectively. Compensatory curve correction was 57% with hooks, 67% with hook pattern screws and 70% with segmental screws. In patients with hypokyphosis, all groups showed significant improvement, with best restoration in segmental screws. Rotational correction of the apical vertebra was 19% with hooks, 26% with hook pattern screws and 59% with segmental screws. Thirteen(3%) screws were malpositioned but they did not cause neurologic impairment nor adversely affect the results of treatment. This study implies that the segmental pedicle screw fixation is safe and effective method of correcting the triplanar deformity of the thoracic idiopathic scoliolis.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Methods ; Pedicle Screws ; Scoliosis ; Spine

PURPOSE: Purpose of this study was to identify major trends of action research from 2006 to 2013 and suggest directions for activating and advancing domestic action research in nursing. METHODS: A review was made of 118 action research studies in hospital settings reported in international journals. Search from PubMed, Ovid, and CINHAL was done using analysis criteria developed by the researchers. General and methodological characteristics and focus on changing outcomes of action research were analyzed. RESULTS: The major group of researchers belonged to colleges/universities (40.7%). Methods included use of qualitative methods (61.0%), research questions (24.6%), and use of theoretical models (35.6%). Prevalent data collection methods were interviews (20.2%), and 48.3% showed more than a 1-cycle process including spiral circulation structure. Focus of changing outcomes of the 56 papers including more than 1-cycle were practice (66.1%), environment (8.9%), client-nurse (7.1%). CONCLUSION: Trends in action research in nursing were identified providing necessary reasons to increase action research in nursing as follows: needs of various researchers including stakeholders as well as healthcare providers, various research designs including unconstrained reflection and writing, specific presentation of adapted theoretical models and action strategies, and quality assurance for validity and reliability of research processes and outcomes.
Data Collection ; Health Personnel ; Health Services Research* ; Humans ; Models, Theoretical ; Nursing* ; Reproducibility of Results ; Research Design ; Writing

Transformation and progression of breast cancer are thought to be caused by an accumulation of complex genetic alterations, but little is known about specific changes. In this study, the author has undertaken a genome-wide screening to detect genetic changes in 20 cases of breast cancer among Koreans, including 16 infiltrating ductal carcinomas, 2 medullary carcinomas, 1 invasive lobular carcinoma, and 1 borderline phyllodes tumor. Comparative genomic hybridization (CGH) was used to screen for DNA sequence gains and losses across all human chromosomes. Simultaneous immunohistochemical staining for c-erbB-2 (Her-2/neu), c-myc, cyclin D1, and p53 protein was done to make comparisons with nuclear grade and that with CGH results. Biotin-labeled tumor DNA and digoxigenin-labeled normal DNA were hybridized to normal metaphase cells. The fluorescence signals were captured by fluorescence microscope after detection by avidin-FITC and anti-digoxigenin rhodamine. Then, the ratio of fluorescence was calculated by an image analyzer. The immunohistochemical staining was done in paraffin-embedded tissue with an LSAB kit and avidin-biotin complex (ABC) method. The CGH results showed gains on chromosomes 8q (40%), 1q (30%), 17q (15%), 20q (15%), 18q (15%), 5p (15%), and 13q (15%). Deletions were on chromosomes 17p (45%) and 22q (20%). High-level amplifications (green/red ratio >1.5) were noted on chromosomes 1p31, 1q, 3q25-qter, 5p, 7q31-qter, 8q, 9p22-qter, 10p, 11p, 11q22-qter, 12p, 12q24, 14q21-qter, 15q23-qter, 17q, 18p, 18q12-qter, 20p, and 20q. By comparison with infiltrating ductal carcinoma, the two medullary carcinomas showed high-level amplification on chromosomes 1p31, 1q, 8q, 10p, 11p and 12p. c-erbB-2, c-myc, cyclin D1, and p53 protein expression was immunohistochemically detected in 9 of 20 (45%), 8 of 20 (40%), 10 of 20 (50%), and 13 of 20 (65%), respectively. The results indicate that the amplification on chromosome 8q, 1q and the deletions on chromosomes 17p and 22q are the most frequent genetic alterations in breast cancers among Koreans. The results reveal a different pattern of genetic alteration from previous studies. The CGH results were not correlated with the immunohistochemical profiles. The amplification pattern of medullary carcinomas was quite different from the pattern of infiltrating ductal carcinomas. The CGH was thought to be very useful in the screening of genetic alterations of solid tumors.
Base Sequence ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Lobular ; Carcinoma, Medullary ; Chromosomes, Human ; Comparative Genomic Hybridization* ; Cyclin D1 ; DNA ; Fluorescence ; Humans ; Mass Screening ; Metaphase ; Phyllodes Tumor ; Rhodamines

Bile* ; Child, Preschool* ; Female* ; Humans

BACKGROUND: Propofol is an alternative to thiopental as an intravenous induction agent for cesarean section. It is also used as a sedative for supplementation of regional blockade during cesarean section. It has been reported that propofol relaxes not only vascular smooth muscle but also other smooth muscles. The aim of this study was to investigate the effect of propofol on rat uterine smooth muscle in an isolated preparation in the rat. METHODS: Uterine smooth muscle tissues were obtained from rats (n = 21). The muscle strips were suspended in tissue baths and isometric tension was recorded. After spontaneous or oxytocin induced activity had been accomplished in the buffer solution as a control, propofol (1 to 20microgram/ml) in fat emulsion was applied cumulatively to the bath and the effects were continuously recorded. RESULTS: In vitro, propofol induced a dose-dependent inhibition of spontaneous as well as oxytocin induced myometrial contractile activity. Propofol concentration of 1microgram/ml had no significant effects on the resting tension, active tention, and frequency of contraction developed by spontaneous and oxytocin induced uterine contractility. However, Complete muscular relaxations on spontaneous and oxytocin induced contractility were obtained at a concentration of 10microgram/ml and 20microgram/ml, respectively. CONCLUSIONS: Propofol inhibits spontaneous and oxytocin-induced uterine smooth muscle contractions in dose dependent pattern.
Animals ; Baths ; Cesarean Section ; Female ; Muscle, Smooth* ; Muscle, Smooth, Vascular ; Oxytocin ; Pregnancy ; Propofol* ; Rats* ; Relaxation ; Thiopental

Pregnancy-induced hypertension(PIH) is a syndrome of hypertension, proteinuria, generalized edema and occasionally superimposed convulsions after the 20th weeks of gestation. It is a cause of maternal morbidity and mortality. Causes of marternal mortality from PIH include intracranial hemorrage, cerebral edema and pulmonary edema. Mitral regurgitation(MR) is the second most common valvular defect in pregancy, but well tolerated by pregnant women. The reduced systemic vascular resistance characteristic of pregnancy may even reduce the intensity of the murmur of MR becauce of increased forward flow and less backward flow. Acute MR result in a sudden and dramatic increase in left atrial pressure that can lead to pulmonary congestion, pulmonary hypertension and right heart failure. This is a case report of patient with toxemia and MR who underwent emergency cesarean section. She was treated with oxygen, diuretics, steroids, bronchodilators, digitalis, semisitting position, suction and positive end-expiratory pressure(PEEP). She recovered completely.
Atrial Pressure ; Brain Edema ; Bronchodilator Agents ; Cesarean Section* ; Digitalis ; Diuretics ; Edema ; Emergencies* ; Estrogens, Conjugated (USP) ; Female ; Heart Failure ; Humans ; Hypertension ; Hypertension, Pulmonary ; Mitral Valve Insufficiency* ; Mortality ; Oxygen ; Pregnancy ; Pregnant Women ; Proteinuria ; Pulmonary Edema* ; Seizures ; Steroids ; Suction ; Toxemia* ; Vascular Resistance