We designed this study to analyze the causes of repeat surgery in the low back disorder after primary procedure, to evaluate the risk factors and to suggest the rational approachs can prevent and solve the problems related with repeat surgery. We retrospectively reviewed the medical record and radiographs of 24 patients who had sustained persistent or recurrent pain, failed to extended conservative therapy, showing abnormal myelogram and/or CT scan with nerve root compression, and with segmental instability consistent with patients symptom and sign after the primary procedures. We evaluated the functional outcome according to Kims(1986) criteria. The causes of remained or recurrent pain with neurologic symptom were persistent or aggravated lumbar spinal stenosis in 10 cases(42%), recurrent disc herniation in 4 cases(17%), infection in 3 cases(12%), instability in 2 cases(8%) and others in 5 cases(20%). Satisfactory outcome was recorded in 79%(19/24) of patients. The characteristics of the patients associated with satisfactory outcome were those who operated by recurrent disc herniation, instability, retained disc, metal malposition, and nerve root compression by bone chip. But the characteristics of the patients associated with unsatisfactory outcome were those who operated by infection, lumbar spinal stenosis aggravated by degenerative spondylosis and multiple herniated disc, inadequate decompression of lateral and/or foraminal stenosis in aged patients. The most common lesion site was on L4-5 disc, and unsatisfactory result was expected at the upper lumbar spine involvement. Favorable outcome could be expected in the presence of a pain-free interval more than 1 year from the date of the previous operation or persistent symptoms immediately after the initial operaion. We were expected the risk factors leading to repeat surgery were old aged(more than 60) patients, upper lumbar spine involvement and multiple lumbar disc herniation. Postoperative diskitis or osteomyelitis, pain free interval more than 1 month or less than 1 year, and those who had a revision on the lumbar spine previously could be considered as a poor prognostic indicators. When surgery is indicated for degenerative lumbar spinal disorders, adequate diagnostic tests and the execution of appropriate procedures based upon this information should be carried out to prevent the repeat surgery in the low back disorders. Adequate postoperative management can reduce the occurrence of failed back surgery syndrome and in cases necessitating repeat surgery, thorough analysis of causes following proper surgical stabilization can reduce the operative morbidity with early return to daily life.
Constriction, Pathologic ; Decompression ; Diagnostic Tests, Routine ; Discitis ; Failed Back Surgery Syndrome ; Humans ; Intervertebral Disc Displacement ; Medical Records ; Neurologic Manifestations ; Osteomyelitis ; Radiculopathy ; Reoperation* ; Retrospective Studies ; Risk Factors ; Spinal Stenosis ; Spine ; Spondylosis ; Tomography, X-Ray Computed

The ankle is a complex structure supporting the entire musculoskeletal system during standing and walking. The injuries to the ankle joint result in a severe functional disturbance because of complex anatomical characteristics around the ankle joint. 69 patients(72 cases) of the ankle fracture that were treated in Orthopedic Dept. Chonbuk National University Hospital from Jan. 1979 to Dec. 1983 were analized in clinical and radiological aspects. The following results were obtained: 1. Among the 69 patients, male was 54 and female 15 with ratio of 3.5: 1.The average age was 32. 2. Main cause of fracture was traffic accident(58%). 3. The musculoskeletal system was injured most frequently associated with the ankle fracture(66%). 4. According to the ankle fracture classification, the most common type was Pronation-external rotation type in Lauge-Hansen classification, and the type C in Weber classification. 5.The average duration of cast immobilization was 8.8 weeks in closed reduction and 7.4 weeks in open reduction. 6. The lateral malleolar fracture involving the distal tibiofibular syndesmosis was very important in ankle stability so accurate anatomical reduction by internal fixation was necessary for satisfactory functional results. 7. In clinical and radiological analysis, the better results were obtained from open reduction.
Ankle Fractures ; Ankle Joint ; Ankle ; Classification ; Clinical Study ; Female ; Humans ; Immobilization ; Jeollabuk-do ; Male ; Musculoskeletal System ; Orthopedics ; Walking

Epithelioid hemangioendothelioma is a recently described vascular neoplasm characterized by epitheloiod endothelial linings and its borderline biologic behavior. We report a case of epithelioid hemangioendothelioma in a 6-year-old male. The tumor was presented as a non-tender dermal nodule on the left middle finger. The microscopic sections revealed irregular proliferation of vascular channels lined by epithelioid cells with histiocytoid features and frequent intracytoplasmic vacuoles, mimicking so called signet ring cells. Immunohistochemical stainings for factor VIII and vimentin were positive both in epithelioid and vacuolated endothelial cell. Electron microscopic finding reveals abundant intermediate filaments.

PURPOSE: The purpose of this study was to develop a breastfeeding empowerment program and to investigate the effects of the breastfeeding empowerment program on self-efficacy, adaptation and continuation of breastfeeding for primiparous women. METHODS: The 5 session breastfeeding empowerment program was developed and a non-equivalent control group non-synchronized quasi-experiment design was used. Fifty-five participants were assigned to either the experimental group (n=27) or the control group (n=28). Effects were tested using repeated measures ANOVA and χ²-test. RESULTS: Scores for self-efficacy, adaptation and continuation of breastfeeding of in the experimental group after program were significantly higher than 1 week, 4 weeks, 8 weeks scores in control group. CONCLUSION: The effects of the breastfeeding empowerment program for elevating self-efficacy, adaptation and continuation of breastfeeding in primiparous women were validated. Therefore, this program can be recommended for vigorous use in clinical practice.
Breast Feeding* ; Female ; Humans ; Power (Psychology)* ; Self Efficacy

No abstract available.
Scalp*

No abstract available in English.
Femur Neck

Macrodactyly, a disproportionate enlargement of one or more fingers or toes, is generally regarded as a rare congenital malformation. The skin, finger nail, subcutaneous fat tissue, vessels, nerves, tendons and phalanges are all enlarged. and the basic lesion appears to be the accumulation of fibrofatty tissue. The authors have recently experienced a case of pedal macrodactyly occured in the 4th and 5th toes of right foot, which was treated with ablation of the involved toes at the level of 4th and 5th metatarsal shaft. Postoperative course was uneventful. This paper is to present a case of pedal macrodactyly in 18 years old boy, experienced recently at our department and review the references relevant to macrodactyly.
Fingers ; Foot ; Humans ; Male ; Metatarsal Bones ; Skin ; Subcutaneous Fat ; Tendons ; Toes

Epithelioid sarcoma is malignant tumor described by Enzinger, that is likely to be confused with a varety of benign and malignant conditions, especially a granulomatous process, a synovial sarcoma Or an ulerating squamous cell carcinoma. The tumor occurs chiefly in young adult and most commonly affects the soft tissue of the hand, the forearm and the pretibial region. The tumor is characteristically a slowly growing lesion but frequent recurrence is common and metastasis were most frequent in the lung. In this paper, we reported one case which is believed to be epithelioid sarcoma in the forearm.
Carcinoma, Squamous Cell ; Forearm ; Hand ; Humans ; Lung ; Neoplasm Metastasis ; Recurrence ; Sarcoma ; Sarcoma, Synovial ; Young Adult

PURPOSE: The aim of this study was to evaluate the clinical manifestations, contact history, and status of tuberculosis contact investigations in school-age children and adolescents with pulmonary tuberculosis (TB) at two centers. METHODS: This study was conducted with 54 patients in the age ranging from 10 to 18 years, who were diagnosed with pulmonary TB at the Pusan National University Hospital and Pusan National University Children's Hospital, January 2008 to December 2012. We retrospectively reviewed the medical records of the patients. RESULTS: The median age of the patients was 16 years old; 11 patients were aged 10 to 14 and 43 patients were aged 15 to 18. Among 54 patients, 19 had history of contact with pulmonary TB, 10 had contact with house members (household), and remaining 9 had contact with classmates (non-household). One out of 10 patients who had household contacts and 6 out of 9 patients who had non-household contacts were evaluated with contact investigation after the exposure to pulmonary TB. Among 7 patients who were evaluated with contact investigation, 3 were diagnosed with active pulmonary TB, 1 had latent tuberculosis infection (LTBI), and 3 had no evidence of TB or LTBI. The median period of diagnosis after the exposure to active pulmonary TB was 2 years in patients with household contacts and 0.23 years in patients with non-household contacts. CONCLUSION: This study suggested that if the contact investigation conducted properly, it would be helpful for early diagnosis and prevention of pulmonary TB.
Adolescent* ; Busan ; Child* ; Diagnosis ; Early Diagnosis ; Family Characteristics ; Humans ; Latent Tuberculosis ; Medical Records ; Retrospective Studies ; Tuberculosis* ; Tuberculosis, Pulmonary*

The purpose of this study is to analyze the structural pattern of nurses' pain management with patients who experience pain. As a research method, the Q methodology, which is useful for an objective view of a highly abstract concept, was applied. The data collecting activity of this study was from August, 21st, 2000 to November, 24th 2000. The Q-population, the previous thesis and a literature review were done. Questions about pain management by the nurse on the patients, caregivers, nursing students, doctors, nurses, and others were asked in documentary work and in-depth interviews. In all, 223 units of the Q-population were formed, and the last 35 units of the Q-population were extracted. The data on the P-sample was collected from 41 nurses who worked in the medical and surgical units of a hospital that belonges to C university in Seoul. The research results were constituted in 3 types. Type I was the 'pattern of judging by objectivity'. The statement on which most of the people highly agreed for those patterns was shown by 'If patients said that they are suffering from pain, we sufficiently performed an assessment about the etiology, location, duration and degree'. For type I, the same pain was found in different locations according to the patients, so the etiology of the pain should be identified first place. Since ways of coping are different according to pain etiology, it was thought that it is important to assess sufficiently the pain etiology, location, duration, and degree. Therefore, when patients complain of pain, the pain etiology should be identified and assessed; according to the result, pain management should be performed systematically. Type II was the 'pattern of accepting by subjectivity'. The statement on which most of the people highly agreed for those patterns was shown as 'If patients said that they are suffering from pain, the medical treatment should be performed rapidly and speedily.' For type II, when the patient complains of pain, treatment should be performed quickly in order to prevent the condition getting worse, and it is thought that activity is a reasonable duty. Further, by trying to show empathy after pain is admitted and by understanding and coping rapidly with the pain of patients, an attitude which matched the altruistic morals of nurses is being shown. Type III was the 'pattern of worrying about', and the statement on which most of the people highly agreed for those patterns was shown is 'When there is a pain, to help patients to tolerate the pain to the highest degree.' In type III, the pain is a subjective expression, so there is a difference according to every individual. Therefore, actually if there is no measurement of pain, it could be exaggerated so nurses should help patients to tolerate it to the utmost. Even if there is a way to remove pain without an analgesic drug, nurses were reluctant to perform pain management as they possibly could. Through these research results, pain management of nurses was classified in 3 types, and structural characteristics in each type were discovered. Based upon the characteristics according to the type, an individualized pain management intervention strategy should be established and the follow up work performed.
Caregivers ; Empathy ; Humans ; Morals ; Pain Management* ; Seoul ; Students, Nursing