PURPOSE: The purpose of this study was to offer the baseline data for developing a systematic and high quality of clinical practice guideline by exploring how nurses utilize clinical guidelines and what they need for. METHOD: This study has been done with 242 nurses of a university hospital in Daegu using a self-administered questionnaire. The instrument used in this study was developed by researchers based on the results of the previous studies. Data analysis was done with SPSS 11.0 Program. RESULTS: Nurses felt that clinical guidelines were not sufficiently disseminated to update their clinical knowledge education. Nurses showed the strong demand for developing clinical practice guidelines with the newest and systematic evidence. However, a relatively low number of nurses knew evidence-based nursing and evidence-based clinical guidelines. CONCLUSION: It is necessary to develop an educational program for evidence-based nursing and an evidence-based nursing clinical practice guideline for nurses and to explore the strategies for development and dissemination of evidence-based clinical practice guidelines to solve the urgent and frequent clinical problems.
Daegu ; Education ; Evidence-Based Nursing ; Statistics as Topic ; Surveys and Questionnaires

A postanesthetic recovery score to provide objective information on the phsical condition of patients arriving in the recovery room after anesthesia. The status of the patients was judged after arriving in the recovery room and every 30minutes thereafter, until their discharge to the ward or Intensive Care Unit. To study this method, 324 patients were selected at random to include as many variants of anesthesia as possible. The patients were transported to the recovery room within 10 minutes of the completion of the anesthesia; Once there, the first score was made by the anesthesiologist. Thereafter, the evaluation was made by the same anesthesiologist. Depending on the length of stay in recovery room, this evaluation was repeated 30, 60, and 90 minutes after the patients arrival. The various signs were evaluated. The independent variables such as age, sex, physical status, anesthetic agents or technics, type of surgery, use of muscle relaxants, duration of anesthesia were correlated with the proportional number of patients receiving top or safe score 10, 9 or 8, and those given 7 or less, which were considered low or dangerous.
Anesthesia ; Anesthetics ; Humans ; Intensive Care Units ; Length of Stay ; Recovery Room*

PURPOSE: The anterolateral thigh flap has many advantages over other conventional free flaps. But the anterolateral thigh flap has yet to enter widespread use because perforating arteries exhibit a wide range of anatomic variations and are difficult to dissect when small. The aim of this study is to identify the vascular variability of perforating arteries and pedicle in the anterolateral thigh free flap. METHODS: We studied 12 cadavers and dissected 23 thighs. An anterolateral thigh flap (12x12cm) was designed and centered at the midpoint of the line drawn from anterior superior iliac spine to the superolateral border of the patella. After we identifed the perforating arteries we dissected up to their origin from lateral circumflex femoral artery along descending branch of lateral circumflex femoral artery. We then investigated the number and the position of perforating arteries, length and diameter of vascular pedicle and pattern of lateral circumflex femoral arterial system. RESULTS: On average 2.3+/-1.1 perforating arteries per thigh were identified. The musculocutaneous perforators were 63.1%. In those perforators five perforators were arose from transverse branch of lateral circumflex femoral artery and two were arose from rectus femoral artery. Most of the perforators were near the intermuscular septum between rectus femoris muscle and vastus lateralis muscle. The length and diameter of pedicle were 11.9+/-3.5cm and 3.1+/-0.8mm on average. CONCLUSION: This study will be helpful for the success in anterolateral thigh free flap.
Anatomy, Regional ; Arteries ; Cadaver ; Femoral Artery ; Free Tissue Flaps ; Muscles ; Patella ; Quadriceps Muscle ; Spine ; Thigh

PURPOSE: The oral teratoma is found approximately in live birth at the rate from 1:35,000 to 1:200,000. In a review of literature 16 cases of midline teratoma with cleft palate were reported. We report a case of congenital palatal teratoma with cleft palate in a 1-year-old girl. METHODS: A 1-year-old girl was admitted our institution for the closure of cleft palate. On the intraoperative findings there was 4x1x0.5cm sized hairy soft mass at the midline and complete cleft palate. We did incisional biopsy intraoperatively and its pathology revealed heterotopic brain tissue. The excision of remaining mass and palatoplasty with Sommerlad's method were performed. The final pathology of the mass was mature cystic teratoma. RESULTS: After the operation there were neither recurrence nor oronasal regurgitation. CONCLUSION: We report for one patient with congenital palatal teratoma associated with cleft palate and obtained an excellent result.
Biopsy ; Brain ; Cleft Palate* ; Female ; Humans ; Live Birth ; Pathology ; Recurrence ; Teratoma*

PURPOSE: As a recipient vessel, internal mammary vessels have many advantages for microvascular reconstruction of the breast. But the approach is time consuming and results in large morbidities. However, the perforating branches of the internal mammary vessels can be used to minimize such demerits. The purpose of this cadaver study is to clarify the location and diameter of the perforating branches of internal mammary vessels and to prove that they are safe and reliable recipient vessels. METHODS: We studied 11 formalin-fixed cadavers and dissected their anterior chests bilaterally. The chests were exposed using midline presternal incisions. We dissected and found all perforators at subfascial planes under loupe magnification. The number, external diameter, and the distance from the midline were measured. Result: The mean external diameter of the arterial perforators was 1.32mm and the mean external diameter of the venous perforators was 1.48mm. The largest arterial and venous perforators were most frequently found in the second intercostal space. The mean distance from the midline to the perforator was evaluated; the artery averaged 1.95cm and the vein averaged 2.08cm. CONCLUSION: This study will be helpful when using the internal mammary perforating vessels as a recipient vessel during breast reconstruction.
Arteries ; Breast ; Cadaver ; Glycosaminoglycans ; Mammary Arteries ; Thorax ; Veins

Glabellar frown lines develop as a result of contraction of the corrugator supercilii muscles. These lines make look angry or aging. The neurotomy of facial nerve supplying corrugator supercilii muscle will prevent complications of the surgical technique and the reversibility of the nonsurgical technique. The regional anatomy of corrugator supercilii muscle is necessary for developing new technique. However, there is little information regarding the motor innervation of this muscle. The purpose of this study is to identify the regional anatomy of corrugator supercilii muscle and facial nerve and help to develop new technique of the neurotomy. We have dissected 6 Korean adult cadavers(12 sides). The motor innervation of this muscle was the temporal branch of facial nerve. The entry point of facial nerve into this muscle was found to be the inferolateral part. It was directly beneath the hair of lateral side of mid one-third of the eyebrow. The average distance between median plane and the entry point was 35.8mm. The measurement was not significantly different between right and left side. This study will be helpful for developing new technique of the neurotomy of motor nerve that supplies to corrugator supercilii muscle.
Adult ; Aging ; Anatomy, Regional* ; Equipment and Supplies ; Eyebrows ; Facial Nerve* ; Hair ; Humans ; Muscles

PURPOSE: Recently, the incidence of malignant melanoma has been steadily increasing. Malignant melanoma is already known to have poorer prognosis than other primary skin cancers. Despite the poor prognosis, it is relatively less known to the public so that a number of patients visit hospital carrying advanced stage tumor. Yet, extensive study about malignant melanoma is currently insufficient, and specific guidelines and statistical figures in Korea are almost inexistent. Therefore, authors reviewed patients with malignant melanoma who have visited our hospital for last 14 years. METHODS: Between January 1994 and January 2008, 62 patients were diagnosed with malignant melanoma at our hospital. A retrospective study was performed with data from patients' charts and biopsy results. Annual incidence, mean age of onset, gender, tumor location, tumor thickness, pathologic ulceration, clinicopathologic subtype, and clinical AJCC stage were evaluated. Analysis of factors associated with survival were performed using the Cox proportional hazard model. Kaplan-Meier method was used to generate survival curves. RESULTS: Clinicopathologic features of 62 patients (32 male, 30 female) with average age of 57 years were evaluated. Most lesions were found in lower limb, and the most common subtype was acral lentiginous melanoma. We could also find that age, tumor thickness, and clinical stage were the only significant prognostic factors. CONCLUSION: Clinicopathologic features of malignant melanoma were analyzed in this study, but the result is not ready to be generalized because of the limited number of cases. Further study must be performed to report clinical guidelines for prognosis and treatment for malignant melanoma patients in Korea.
Age of Onset ; Biopsy ; Humans ; Incidence ; Korea ; Lifting ; Lower Extremity ; Male ; Melanoma ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Skin Neoplasms ; Survival Rate ; Ulcer

PURPOSE: Pyoderma gangrenosum is a rare cutaneous ulcerative disease. First described in 1930, the condition is characterized by progressive ulceration with deeply undermined purple-red edge.(1) The lower extremities are most commonly affected but other parts of the skin and mucous membranes may also be involved. Although medical treatments with topical wound therapy are commonly used, surgical intervention is still controversial. In this paper, we report an atypical case of pyoderma gangrenosum which was characterized by extensive soft tissue breakdown. METHODS: A 27-year-old male patient was referred to our institution with a 7 x 8 cm sized deeply undermined ulceration with pus-like discharge and fever. Incision and drainage was performed at another clinic 3 days prior to admission to our institution. After a thorough physical examination and the MRI review, a diagnosis of necrotizing faciitis was made. Accordingly, fasciotomy and debridement was performed. However, the wound enlarged progressively and the patient remained highly febrile for 9 days after the treatment. Septic screening did not reveal any occult infection. After a secondary review of the case, the initial diagnosis of necrotizing fasciitis was rejected and changed to pyoderma gangrenosum. With the use of dexamethasone intravenously, the wound improved dramatically and the fever was eliminated. Steroid mediation was tapered with duration of 1 month. The wound was stabilized and subsequently covered with split-thickness skin graft. RESULTS: Split-thickness skin grafting with 1:1.5 mesh was successfully taken. CONCLUSION: Initial clinical features of pyoderma gangrenosum are very similar to that of necrotizing fasciitis. High fever and progressive ulceration with severe pain could invite earlier surgical approach. The advancing wound margins (the well defined violaceous, undermined border and necrotic ulcer base) and lack of isolation of pathogenic organism was used to make the correct diagnosis of pyoderma gangrenosum. We achieved a good result with proper medication and split-thickness skin graft.
Adult ; Debridement ; Dexamethasone ; Drainage ; Fasciitis, Necrotizing ; Fever ; Humans ; Lower Extremity ; Male ; Mass Screening ; Mucous Membrane ; Necrosis ; Negotiating ; Physical Examination ; Polyenes ; Pyoderma ; Pyoderma Gangrenosum ; Skin ; Skin Transplantation ; Transplants ; Ulcer

To understand the seroepidemiological patterns of haemorrhagic fever with renal syndrome in Korea, a nation-wide survey collaborated with fourteen clinics was carried out from 1994 to 1996. Sera of 4,547 patients with acute febrile episodes were tested by indirect immunofluorescent antibody test and the seroepidemiological analysis including sex, age, seasonal and regional distributions were performed. According to the results obtained in this study, the epidemiological characteristics of haemorrhagic fever with renal syndrome in Korea were summarized as follows: 1. Seropositive rate of hemorrhagic fever with renal syndrome among the patients with acute febrile episodes was 6.4% by the cut-off point of 1:40. 2. Among the seropositives, male outnumbered female and the ratio of males to females was 2.0:1.0. 3. Seventy six % of the seropositive patients were 21-60 years old. 4. The number of seropositive cases increased from October and reached maximum in December and began to decrease gradually from January. 5. The geographical distribution of the seropositives cover most areas including Cheju province in Korea.
Female ; Fever ; Hemorrhagic Fever with Renal Syndrome* ; Humans ; Jeju-do ; Korea* ; Male ; Seasons

In the field of orofacial surgery, a red blood cell transfusion (RBCT) is occasionally required during double jaw and oral cancer surgery. However, the question remains whether the effect of RBCT during the perioperative period is beneficial or harmful. The answer to this question remains challenging. In the field of orofacial surgery, transfusion is performed for the purpose of oxygen transfer to hypoxic tissues and plasma volume expansion when there is bleeding. However, there are various risks, such as infectious complications (viral and bacterial), transfusion-related acute lung injury, ABO and non-ABO associated hemolytic transfusion reactions, febrile non-hemolytic transfusion reactions, transfusion associated graft-versus-host disease, transfusion associated circulatory overload, and hypersensitivity transfusion reaction including anaphylaxis and transfusion-related immune-modulation. Many studies and guidelines have suggested RBCT is considered when hemoglobin levels recorded are 7 g/dL for general patients and 8-9 g/dL for patients with cardiovascular disease or hemodynamically unstable patients. However, RBCT is occasionally an essential treatment during surgeries and it is often required in emergency cases. We need to comprehensively consider postoperative bleeding, different clinical situations, the level of intra- and postoperative patient monitoring, and various problems that may arise from a transfusion, in the perspective of patient safety. Since orofacial surgery has an especially high risk of bleeding due to the complex structures involved and the extensive vascular distribution, measures to prevent bleeding should be taken and the conditions for a transfusion should be optimized and appropriate in order to promote patient safety.
Acute Lung Injury ; Anaphylaxis ; Cardiovascular Diseases ; Emergencies ; Erythrocyte Transfusion* ; Erythrocytes* ; Graft vs Host Disease ; Hemorrhage ; Humans ; Hypersensitivity ; Jaw ; Monitoring, Physiologic ; Mouth Neoplasms ; Oxygen ; Patient Safety ; Perioperative Period ; Plasma Volume ; Transfusion Reaction