Background: Proximal humerus fractures account for 2% of all pediatric fractures. A nonoperative approach is the treatment of choice for most of these fractures; however, debates continue regarding the treatment of displaced fractures, especially in adolescents. In this study, we aimed to examine demographic data and treatment strategies for proximal humerus fractures in the pediatric population by conducting a meta-analysis. Additionally, we investigated the preferred surgical technique for operative treatment. Methods: A systematic online search of databases, including Embase, Medline, PubMed, and Cochrane Library, was conducted to identify studies that matched our search criteria. Data collection was completed on May 1, 2022. Age, sex, degree of angulation, Neer-Horwitz classification, Salter-Harris classification, treatment method (operative vs. nonoperative), and instrument used for internal fixation were classified and documented. Effect size analysis was performed using odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs), based on data types. Results: Eight studies met our inclusion criteria. Overall, 33% of the patients (n = 195) underwent operative treatment, whereas 67% of them (n = 392) received nonoperative treatment. Among the demographic risk factors, severely displaced fracture type (OR, 10.00; 95% CI, 1.56−64.22; p = 0.020) and older age (WMD, 3.26; 95% CI, 2.29−4.23; p < 0.001) were significantly associated with operative treatment. There was no significant difference in the preference for percutaneous pinning or intramedullary nailing, the most frequently employed surgical techniques (OR, 5.09; 95% CI, 0.65−39.58; p = 0.120). Conclusions The operative treatment rate in pediatric proximal humerus fractures was 33%, which increased to 60% in severely displaced fractures (Neer-Horwitz grade III/IV). Severely displaced fractures and older age significantly contributed to the establishment of a treatment strategy for operative treatment. The choice of surgical technique may seem to be based on the anatomical location of the fracture rather than the surgeon’s preference.

BACKGROUND: Compared with conventional routes of delivering potent analgesics to postoperative patients, transdermal administration of fentanyl offers the advantages of simplicity and noninvasiveness. The analgesic efficacy and safty of transdermal fentanyl patch (TDFP) were evaluated postoperatively. METHOD: TDFP releasing 25 mcg/hr (Group 1) or placebo (Group 2) were applied to 40 women 6 hours before total abdominal hysterectomy under the general anesthesia. Postoperatively, self-administered intravenous fentanyl was maintained with a 20-mcg incremental dose and a 10-min. locking interval. Each group was assessed following 48 hours with respects to vital signs, VAS pain scores, hourly-used fentanyl doses, satisfaction scores and side effects. RESULT: VAS observed 24 hours, 36 hours after operation were significantly lower in group 1 than group 2. Hourly-used fentanyl doses were significantly lower in group 1 than group 2 at 2 hours, 6 hours, 12 hours and 24 hours after operation. The incidence of side effects were similar between group 1 and group 2. CONCLUSION: TDFP-25 mcg applied 6 hours before operation provides supplementary analges-ia after the postoperative period without significant side effects such as respiratory depression.
Administration, Cutaneous ; Analgesics ; Anesthesia, General ; Female ; Fentanyl* ; Humans ; Hysterectomy* ; Incidence ; Postoperative Period ; Respiratory Insufficiency ; Vital Signs

OBJECTIVE: To investigate the association between endometriosis and polymorphisms of N-acetyl transferase 2 (NAT2), glutathione S-transferase M1 (GSTM1), and cytochrome P450 (CYP) 1A1 genes in Korean infertile patients. MATERIALS AND METHODS: A total of 303 infertile patients who had undertaken diagnostic laparoscopy during January, 2001 through December, 2003 at Samsung Cheil Hospital enrolled in this study. The patients were grouped according to laparoscopic findings: minimal to mild endometriosis (group I: n=147), moderate to severe endometriosis (group II: n=57), normal pelvic cavity (n=99). Peripheral blood was obtained and genomic DNA was extracted. The genotypes of each genes were analyzed using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). For NAT2, RFLP was used to detect the wild type (wt) and mutant (mt) alleles, enabling classification into slow (mt/mt) or fast (wt/wt or wt/mt) acetylation genotypes. For GSTM1, PCR was used to distinguish active (+/- or +/+) from null (-/-) genotypes. For CYP1A1, MspI digestion was used to detect the wild type (A1A1), heterozygote (A1A2) or mutant (A2A2) genotypes. RESULTS: The genotype frequencies of NAT2 slow acetylator was 12.8%, 10.9%, 12.8% in group I, group II and control, respectively. The genotype frequencies of GSTM1 null mutation was 55.3%, 41.8%, 53.2% in group I, group II and control, respectively. The genotype frequencies of CYP1A1 MspI polymorphism was 16.3%, 9.1%, 18.1% in group I, group II and control, respectively. No significant difference was observed between endometriosis and normal controls in the genotype frequencies of the NAT2, GSTM1, CYP1A1 MspI polymorphism. CONCLUSION: The NAT2, GSTM1, CYP1A1 gene polymorphism may not be associated with the susceptibility of endometriosis in Korean women.
Acetylation ; Alleles ; Classification ; Cytochrome P-450 CYP1A1 ; Cytochrome P-450 Enzyme System* ; Cytochromes* ; Digestion ; DNA ; Endometriosis* ; Female ; Genotype ; Glutathione Transferase* ; Glutathione* ; Heterozygote ; Humans ; Laparoscopy ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Transferases*

PURPOSE: To evaluate photodynamic therapy (PDT) with verteporfin for iris and angle neovascularization in eyes with neovascular glaucoma. METHODS: We treat a patient who had neovascular glaucoma with iris and angle neovacularization and showed reduction of intraocular pressure (IOP) and the obliteration of neovascularization after PDT. PDT was performed following the treatment parameters used in age-related macular degeneration. The laser was directed at the anterior chamber angle and iris surface using a Goldmann three-mirror contact lens. Follow-up examination was performed 1, 2, 3, 5, 7, and 8 weeks after PDT, and included visual acuity, IOP, and iris fluorescein angiography (7 weeks after PDT). RESULTS: Two months after PDT, we observed a reduction of IOP and the improvement of iris fluorescein leakage. IOP diminished considerably after 1 week, and showed subsequent tendency toward stabilization without additional antiglaucoma medicine. CONCLUSIONS: Photodynamic therapy can be used safely and effectively in the early phase of neovascular glaucoma to achieve the obliteration of iris and angle neovascularization and induce IOP reduction.
Anterior Chamber ; Fluorescein ; Fluorescein Angiography ; Follow-Up Studies ; Glaucoma, Neovascular ; Humans ; Intraocular Pressure ; Iris ; Macular Degeneration ; Photochemotherapy* ; Visual Acuity

A histopathological study of erythema nodosum-like lesions in Behcet's disease was performed on 55 patients with incomplete and suspect types of Behcet's disease. Relatively common characteristics in histopathology of erythema nodosum-like lesions could be found in the patients with incomplete type of Behcet's disease. The histopathologic findings of erythema nodosum-like lesions in 21 patients with incomplete type of Behcet's disease were as follows : l. A moderate lymphocytic infiltration was found around the blood vessels and the sweat glands in the dermis. In the subcutaneous tissue, besides lymphohistiocytic infiltration, neutrophils were present in significant number in 9 cases (42.9%) 2. Vasculitis of small vessels was found within the periphery of fat lobules in 7 cases (81.0%), Five cases (23.8%) also showed thrombophlebitis. Seven cases (33.3%) showed histiocytic granuloma formation within the fat lobules. Microabscess formation in the subcutaneous tissue was seen in 5 cases (23.8 %), but it was not certain whether this was the charateristic feature.
Blood Vessels ; Dermis ; Erythema Nodosum* ; Erythema* ; Granuloma ; Humans ; Neutrophil Infiltration ; Subcutaneous Tissue ; Sweat Glands ; Thrombophlebitis ; Vasculitis

PURPOSE: To present a case of brain abscess formation accompanied by improvement of orbital cellulitis. CASE SUMMARY: A 54-year-old male came to our clinic complaining of swelling and pain of the left periorbital area and decreased visual acuity (VA) of the left eye. Initial best-corrected visual acuity (BCVA) was 0.3 and intraocular pressure was 27 mmHg in the left eye. Eye movement in all directions was restricted and 4 mm of proptosis was observed in the left eye. An orbital CT scan demonstrated pansinusitis and orbital cellulitis of the left eye. The patient underwent endoscopic sinus surgery and was treated with systemic antibiotics. However, periorbital swelling was aggravated and another orbital CT scan was performed and analyzed. The CT scan showed localized periorbital abscess of the left eye, and the authors performed an incision and drainage (I&D) of abscess procedure. After the operation, BCVA of the left eye was recovered to 0.8 and eye movement improved and periorbital swelling decreased. However, 15 days after the I&D, the patient complained of a severe headache. Brain magnetic resonance imaging (MRI) was performed and showed an abscess of the left frontal lobe of the brain. The authors consulted with a neurosurgeon, and the patient received intravenous antibiotics and mannitol. The headache steadily decreased, and three months after the first visit, a follow-up brain MRI was performed. The MRI showed almost complete disappearance of the abscess and six months after the first visit, BCVA was recovered to 1.0 and eye movement was full in all directions. CONCLUSIONS: Although orbital cellulitis is improved by treatment of antibiotics and surgery, if the patient complains of neurologic symptoms such as headache, other complications such as brain abscess formation should be considered.
Abscess ; Anti-Bacterial Agents ; Brain ; Brain Abscess ; Drainage ; Exophthalmos ; Eye ; Eye Movements ; Follow-Up Studies ; Frontal Lobe ; Headache ; Humans ; Intraocular Pressure ; Magnetic Resonance Imaging ; Male ; Mannitol ; Middle Aged ; Neurologic Manifestations ; Orbit ; Orbital Cellulitis ; Porphyrins ; Sinusitis ; Visual Acuity

PURPOSE: This study was performed to investigate the perceived relationship among professional self-concept, head nurse's leadership, and nursing clinical competency by clinical nurses. METHODS: This study was a cross-sectional survey. Participants were 601 nurses working at the five general hospitals in four provincial cities, Gyeungbuk, Korea. Data were collected from July 14, 2010 to August 31 and analyzed by SPSS/PC ver 18.0 programs. RESULTS: Professional self-concept and head nurse's leadership were slightly above the middle average, but nursing clinical competency was good. According to participants' age, marital status, job satisfaction, and length of service, there were perceptional differences in professional self-concept, head nurse's leadership, and nursing clinical competency. Nursing clinical competency could be explained by head nurse's leadership, professional self-concept, job satisfaction and length of service. Head nurse's leadership was independent variable affecting nursing clinical competency, professional self-concept was partial mediating variable, and job satisfaction and length of service were extraneous variables. CONCLUSION: It is concluded that head nurse's leadership is more important than professional self-concept to improve nursing clinical competency. Nursing managers should plan various strategies to improve head nurse's leadership and professional self-concept, to increase clinical nurses' job satisfaction and length of service.
Cross-Sectional Studies ; Head ; Hospitals, General ; Job Satisfaction ; Korea ; Leadership ; Marital Status ; Negotiating

Breastfeeding is an ideal approach for physical and emotional development of babies, as well as recovery of mothers. A breastfeeding education for female students seems to be an effective intervention to increase the Korean women breastfeeding rate. The purpose of this study was to evaluate their knowledge, attitudes, and other related breastfeeding variables for developing a design for a pre-parental breastfeeding educational information for Korean female students of childbearing age. The sample consisted of 205 Korean female college students, ranging in age from 20 to 25 years old. In this study, a self-administered questionnaire included 6 pages with close-ended multiple-choice questions, and included a cover page with 15 questions on demographic characteristics and personal experiences related to breastfeeding. Data analysis was done utilizing inferential statistics using SPSS 12.0 computer program. The findings indicated that breastfeeding education programs should focus on the practical aspect of attitudes toward breastfeeding, and that educational information design should focus on the practical aspects of breastfeeding for all levels of students' education by nurses. Therefore, education for female college students seems to be an effective intervention to increase breastfeeding rate. This study is useful for descriptions of educational activities to help female students develop positive attitudes to breastfeed, to help these students have confidence toward breast-feeding in future by providing correct information and practical techniques on breastfeeding.
Breast Feeding ; Female ; Humans ; Mothers ; Software ; Statistics as Topic ; Surveys and Questionnaires

We would like to correct the affiliation for the first author.

Osteochondral lesion of the talus (OLT) is a disease affecting the subchondral bone and articular cartilage of the talus, which may cause fragmentation and displacement of the osteochondral lesion. The stability of the joint and the size of the lesion are important prognostic factors. Conservative treatment is preferred in the initial treatment of OLT in skeletal immature patients because it has a more favorable prognosis than adult OLT in terms of the healing potential and improvement of symptoms. Surgery is recommended when the conservative outcome is unsatisfactory and the fragment is large or displaced. Surgical procedures, including marrow stimulation technique, autologous osteochondral transplantation, and autologous chondrocyte implantation, were performed depending on the condition of the osteochondral lesion.
Adolescent* ; Adult ; Ankle ; Bone Marrow ; Cartilage, Articular ; Child* ; Chondrocytes ; Humans ; Joints ; Prognosis ; Talus*