No abstract available.
Thyroid Gland* ; Thyroid Nodule*

Fractures of the femoral neck in children are rare and usually severe violence to occur, which accounts for the high frequency of associated injuries. Since the femoral neck in children has many anatomic and physiologic differences, not only are there many difficulties during the treatment period, but complications such as post-traumatic coxa vara, avascular necrosis of the femoral head, and premature epiphyseal closure may occur, sixty-two cases in sixty patients of fractures of the femoral neck in children which were treated at Severance Hospital, Yonsei University College of Medicine from Jan. 1971 to Dec. 1987 and at Young-Dong severance Hospital, Yonsei University college of Medicine from May. 1983 to Dec. 1987 were analyzed both clinically and radiologically. The following results were obtained: l. Of the 62 cases, the ratio of boys to girls was approximately 2:1 and the highest incidence was between 4 to 6 years old. 2. The main cause of fracture was traffic accidents, which occurred in 33 cases(53.2%). 3. According to the classification of Delbet and Colonna, the cervicotrochanteric fracture was the most common type(41.9% of the cases) and 29 cases(46.8%) were displaced fractures. 4. Thirty two cases(51.6%) were treated by conservative treatment and twenty eight cases (45.2%) by closed reduction and internal fixation. 5. Common associated injuries were genito-urinary tract injury, soft tissue injury, long bone fracture and pevic bone fractures. 6. All cases were followed for from 14 months to 15 years, average 8 years. 7. The results were analyzed according to Ratliff's assessment and 41 cases(66.1%) showed good results. 8. The total number of cases with complications was 33(53.2%). The most common complication being coxa vara and premature epiphyseal closure(32.2%). 9. Secondary treatment was done in 7 cases and correction osteotomy was done in 4 cases which had showed a good results. The authors found that for the treatment of type IV fractures, closed reduction followed by plaster of Paris immobilization was adeguate but for type I, II, III after early closed reduction, internal fixation was performed as soon as possible using threaded pins as the internal fixation device. The results were poor in type I and type II, fractures with severe displacement, and in cases in which the treatment was delayed due to associated injury.
Accidents, Traffic ; Calcium Sulfate ; Child ; Classification ; Coxa Vara ; Female ; Femur Neck ; Fractures, Bone ; Fractures, Closed ; Head ; Humans ; Immobilization ; Incidence ; Internal Fixators ; Necrosis ; Osteotomy ; Soft Tissue Injuries ; Violence

PURPOSE: The aim of this study was to evaluate the process and outcome of a mobile computerized system for individual home visiting healthcare. METHODS: A nonequivalent control group non-synchronized design was employed for this study. The newly constructed system was administered to 80 healthcare providers in the experimental group for 8 weeks. Data were analyzed using descriptive analysis, t-test, and ANCOVA with the SPSS 18.0 program. RESULTS: In the process stage, the difference in the frequency of computerized information usage between the experimental and control groups was significant as 8.88+/-3.20 and 7.08+/-2.92, respectively (t=3.90, p<.001). In the outcome evaluation stage, all kinds of healthy lifestyle such as alcohol use, nutrition, weight management and mental health were not improved. CONCLUSION: The findings of this study showed that the revised mobile computerized system was an effective device for individual visiting healthcare providers. Further advanced strategies for using this system should be developed and applied in a broad range of community healthcare.
Community Health Services ; Health Personnel ; Home Care Services ; House Calls ; Humans ; Life Style ; Mental Health ; Mobile Health Units ; Program Evaluation

Nosocomial pneumonia is a common complication of mechanical ventilation. However the actual incidence of pneumonia associated with ventilator is not known. A total of 57 consecutive patients submitted to mechanical ventilation(MV) for mqre than 48 hours in ICU were studied to investigate the incidence, etiology and consequence of ventilator associated pneumonia. Pneumonia was diagnosed when new and persistent radiographic infiltration was detected together with more than two of the following criteria; (l) fever more than 38degrees C, (2) leukocytosis more than 12000/mm, (3) purulent sputum with s gram stain showing bacteria. The results are as following: l) Twenty-one(37.9%) patients developed bacterial pneumonia during mechanical ventilation 2) Ventilator associated pneumonia was developed after 4.6 days of machanical ventilation 3) The etiology of pneumonia were Gram(-) bacilli 65.8%, Gram(+) bacilli 31.7% and, Pseudomonas 27.9%, Streptococcus 16.5% and or, Staphylococcus 13.9%.
Bacteria ; Fever ; Humans ; Incidence* ; Leukocytosis ; Pneumonia* ; Pneumonia, Bacterial ; Pneumonia, Ventilator-Associated ; Pseudomonas ; Respiration, Artificial* ; Sputum ; Staphylococcus ; Streptococcus ; Ventilation ; Ventilators, Mechanical

Nosocomial pneumonia is a common complication of mechanical ventilation. However the actual incidence of pneumonia associated with ventilator is not known. A total of 57 consecutive patients submitted to mechanical ventilation(MV) for mqre than 48 hours in ICU were studied to investigate the incidence, etiology and consequence of ventilator associated pneumonia. Pneumonia was diagnosed when new and persistent radiographic infiltration was detected together with more than two of the following criteria; (l) fever more than 38degrees C, (2) leukocytosis more than 12000/mm, (3) purulent sputum with s gram stain showing bacteria. The results are as following: l) Twenty-one(37.9%) patients developed bacterial pneumonia during mechanical ventilation 2) Ventilator associated pneumonia was developed after 4.6 days of machanical ventilation 3) The etiology of pneumonia were Gram(-) bacilli 65.8%, Gram(+) bacilli 31.7% and, Pseudomonas 27.9%, Streptococcus 16.5% and or, Staphylococcus 13.9%.
Bacteria ; Fever ; Humans ; Incidence* ; Leukocytosis ; Pneumonia* ; Pneumonia, Bacterial ; Pneumonia, Ventilator-Associated ; Pseudomonas ; Respiration, Artificial* ; Sputum ; Staphylococcus ; Streptococcus ; Ventilation ; Ventilators, Mechanical

PURPOSE: The objective of this study was to define the predictors of health related quality of life(HRQoL) of women caregivers of the demented elderly patients. METHODS: The subjects of this study were 140 pairs of patients with dementia and their caregivers. The characteristics of dementia patients and caregivers, Barthel index and SF-36 were measured in this study. T-test, ANOVA, Pearson correlation coefficient, and stepwise multiple regression were used for data analysis. RESULTS: The health related quality of life(HRQoL) score of women caregivers was 288.35+/-66.10 for norm based scoring. HRQoL of women caregivers was correlated with patients' ADL, severity of dementia, caregivers' age, burden, and family support. The major factors that affected the physical components of women caregivers of patients with dementia was the age of the caregiver, burden, and ADL which explained 36.0% of HRQoL. The main predictors of women caregivers' emotional state was the caregiver's burden. CONCLUSION: Patients' support systems must be implemented to improve the physical HRQoL of caregivers. A caregivers' burden relief program needs to be prepared to increase their emotional HRQoL and further studies and efforts will be needed to evaluate those effects.
Activities of Daily Living ; Adult* ; Aged ; Caregivers* ; Dementia* ; Female ; Humans ; Quality of Life* ; Statistics as Topic

Background: Prolonged mechanical ventilation (PMV) is a common complication after liver transplantation surgery. However, owing to the clinical and economic benefits of early extubation, many efforts have been used to assess the clinical predictors for PMV. The aim of our study was to explore the impact of perioperative risk factors, including candidate gene polymorphisms, for PMV in patients undergoing liver transplantation. Methods: One hundred forty patients who underwent liver transplantation surgery were enrolled. The duration of mechanical ventilation after surgery was examined, along with the length of intensive care unit and hospital stay, and 30-day mortality. Patient-related clinical factors and single nucleotide polymorphisms of candidate genes were assessed with regard to PMV, which was defined as mechanical ventilation for > 48 h. Results: Twenty-six (19%) patients continued to receive mechanical ventilation at 48 h after surgery. Intraoperative continuous renal replacement therapy (CRRT) and an elevated serum lactate level during the postoperative period were significantly associated with the PMV group, compared to the non-PMV group (odds ratio [OR] = 24.731 [1.077, 567.915] versus OR = 3.008 [1.497, 6.045]). A significant association existed between the HLA-DPA1 rs8486 polymorphism and the risk of PMV under the allele model (OR = 8.060 [1.451, 44.765]). Conclusions The rs8486 polymorphism in HLA-DPA1 can independently affect the risk of PMV in liver transplantation recipients, along with intraoperative CRRT application, and elevated lactate level during the postoperative period.

A patient with encephalopathy associated with autoimmune thyroid disease (EAATD), which is one of the most important differential diagnoses of treatable dementia, presents with various neurological symptoms, such as repetitive epileptic seizures, altered mental status, and cognitive dysfunction. Steroid treatment is effective for EAATD. The incidence of EAATD increases considerably with age, particularly in female patients. Most patients with EAATD have normal thyroid function test results or mild hypothyroidism. Patients with EAATD with Graves' disease are very rarely reported. Here, we report a case of a 63-year-old woman who complained of declining cognitive ability and ataxia. She was diagnosed with EAATD accompanied by Graves' disease. Her neurological symptoms improved after intravenous steroid administration.
Ataxia ; Brain Diseases ; Dementia ; Diagnosis, Differential ; Epilepsy ; Female ; Graves Disease* ; Humans ; Hypothyroidism ; Incidence ; Middle Aged ; Thyroid Diseases* ; Thyroid Function Tests ; Thyroid Gland*

PURPOSE: We designed this study to find out the risk factors affecting the patency rate after creation of an arteriovenous fistula (AVF) for hemodialysis. METHODS: Between March 1997 and December 2001, a total of 397 AVF operations in 314 patients were performed by a single surgeon using the same surgical technique and principles. One hundred and forty cases (35.3%) were reoperations due to previous AVF failure. Artificial vessels (=PTFE, polytetrafluoroethylene) were used for the AVF in 39 cases (9.8%). The sex, age, diabetes mellitus, previous operation history and type of dialysis center were considered as a possible risk factors affecting the patency rate. RESULTS: After a mean follow-up of 18.3 months, there were 63 cases of patient death, 15 of kidney transplantation, and 104 of AVF failure identified. The overall patency rates of 1, 2 and 3 year were 76.2, 70.9, and 66.9%, respectively. From the multivariate analysis, the previous operation history was the only significant factor affecting the patency rate of AVF (P=0.001, odd ratio=2.58). Although the diabetic patient (odd ratio=1.43) and artificial vessel groups (odd ratio=1.678) showed high odd ratios, these factors were not statistically significant (P>0.05). From the univariate analysis, the reoperation cases also showed a significantly inferior patency rate compared to the first operation cases (1 year patency rate was 65.2% and 83.7%, P=0.001). However, the diabetes and types of vessel showed no significant differences in patency rates. CONCLUSION: A reoperation of an AVF creation was the most significant risk factor affecting the patency rate after its original creation. The first attempt AVF creations showed-favorable patency rates. To improve the overall patency rate of an AVF creation, a more delicate preoperative study and accurate surgical technique will be required at the time of the first AVF operation.
Arteriovenous Fistula* ; Diabetes Mellitus ; Dialysis ; Follow-Up Studies ; Humans ; Kidney Transplantation ; Multivariate Analysis ; Renal Dialysis* ; Reoperation* ; Risk Factors

Myelodysplastic syndromes (MDS) are a group of refractory anemias resulting from a clonal stem cell disorder often associated with cytogenetic abnormalities. There is increasing recognition of immunological abnormalities in patients with MDS, including defective B- and T-cell function, hyper- or hypogammaglobulinemia and monoclonal gammopathy. MDS have been associated with Sjogren's syndrome, polymyalgia rheumatica, relapsing polychondritis and systemic lupus erythematosus. Although there may be various rheumatologic features, including acute arthritis in MDS, chronic inflammatory arthritis is uncommonly combined. There have been a few reports that described cases of rheumatoid arthritis (RA) concurrent with MDS, but advanced rheumatoid arthritis with typical joint deformities has rarely been reported. We report a case of rheumatoid arthritis with atlantoaxial subluxation combined with refractory anemia in a 31-year-old woman.
Adult ; Arthritis, Rheumatoid/radiography ; Arthritis, Rheumatoid/pathology ; Arthritis, Rheumatoid/complications* ; Arthritis, Rheumatoid/blood ; Case Report ; Female ; Follow-Up Studies ; Human ; Myelodysplastic Syndromes/pathology ; Myelodysplastic Syndromes/complications* ; Myelodysplastic Syndromes/blood