One of the most difficult problems confronting the orthopedic surgeon today is what to do when faced with a large defect in a peripheral nerve. Recent advances in engineering and neurophysiology have improved our technical ability to understand the consequences of severing a nerve. We have treated a large traumatic ulnar nerve defect with microsurgical nerve graft technique. In a follow-up study of twehre monthes post surgery, the results were satisfactory.
Follow-Up Studies ; Neurophysiology ; Orthopedics ; Peripheral Nerves ; Transplants ; Ulnar Nerve

Hemangioma are not rare tumor, they are found in almost all the vascular structures of the body. They are fairly common in the akeletal muscles. There Is no unanimity of opinion concerning the etlology and pathogenesis of hemangioma. It Is most llkely, however, that hemangioma are congenital in origin. The authors have experienced unusual huge skeletal hemangioma occurred in forearm and hand in infant. These huge hemangioma in infant ls very difficult to excise completely with the conventional methods. But we have obtained the excellent result by using recently advanced meticulous microsurgical technique.
Forearm ; Hand ; Hemangioma ; Humans ; Infant ; Muscles

Cerebral metastses secondary to primary epithelial ovarian carcinoma are unusual. The incidence was estimated under 1%, but some authors reported higher incidence than previously reported data. Recently, we experienced a case of cerebral metastasis secondary to primary epithelial ovarian cancer. We present this case with review of brief related literatures.
Drug Therapy* ; Incidence ; Neoplasm Metastasis ; Ovarian Neoplasms

Of the shoulder injuries in trauma, none are more common than those involving the acromioclavicular joint. There are many procedures described for treatment of injuries of the acromioclavicular separation but difficulties continues to be encounted. To know the functional anatomy of this joint and mechanism of injuries makes more proper treatment. We operated the 16 cases of acromioclavicular separation in the Dept of Orthopedic Surgery, Kyung Hee College of Medicine from January 1975 to August 1978. The following results were obtained. 1. This injuries is more prevalent in male with peak incidence in the third and fourth decades. 2. The mechanism of injuries were traffic accident, falling down and the other direct injuries with in orders. 3. The difference of distance between coracoid process and clavicle gives the information of Type II and Type III. 4. The operative procedures in Type II and Type III are good treatment of acromioclavicular separation.
Accidental Falls ; Accidents, Traffic ; Acromioclavicular Joint ; Clavicle ; Humans ; Incidence ; Joints ; Male ; Orthopedics ; Shoulder ; Surgical Procedures, Operative

A clinical study of the Tibial Shaft fracture was made on 128 patients, who had been treated at the Department of Orthopedic Surgery, College of Medicine Kyung Hee Universlty from the October, 1971 to May, 1979. The results were as follows: 1. The rate of fracture union was accelerated under the age of 20 years but it was slow in aged group. 2. The poor prognosis of fracture union was shown in junction between middle and distal 1/3 than others. 3. The better prognosis of the fracture type was shown in oblique and spiral fracture than in the comminuted and segmental. 4. There was prolonged rate of union in case of associated fibula fracture. 5. The frequency of delayed and nonunion were more prevalent in open fracture. 6. Among the open comminuted tibial shaft fracture with skin and soft tissue loss, the good results was obtained by the Hoffmanns external skeletal fixation method.
Classification ; Clinical Study ; Fibula ; Fracture Fixation ; Fractures, Open ; Humans ; Methods ; Orthopedics ; Prognosis ; Skin

Purpose: This study aimed to develop and evaluate the effectiveness of a preceptor educational program in a children’s hospital. The program’s impact was assessed by measuring improvements in clinical competency, communication competency, and leadership competency. Methods: Four day pediatric nurse preceptor education program was developed using the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model. A single-group pretest-posttest design was employed to assess the program’s effects with seventeen participants who were newly trained preceptors. Additionally, participant satisfaction with the program was measured. Results: Following the implementation of the program, significant improvements were observed in clinical competency (Z=-3.62, p<.001), communication competency (Z=-2.77, p=.006), leadership competency (Z=-2.08, p=.038), other competence (Z=-2.64, p=.008), and total competency (Z=-3.52, p<.001) among participants. The overall satisfaction score was 4.41±0.62 on a 5-point scale. Conclusion The pediatric nurse preceptor educational program significantly enhances the overall nursing competencies of preceptor nurses in a children’s hospital. Further research is needed to evaluate the effects of this preceptorship on newly graduated nurses.

Dosage titration of protamine using a heparin dose response curve for the reversal of heparinization after cardiopulmonary bypass and the factors which affect. ACT were investigate. This study included 170 patients undergoing surgery for congenital or acquired heart diseases. Patients were randomly allocated to 6 griyos according to a protamine dosage of either 0.8, 1.0, 1.3, or 1.5 times the residual heparin amounts, or protamine 3mg/kg. The factors affecting ACT which we investigated were the differences between arterial and venous blood, between men and women, between a hematocrit value less of greater than 40%, and between less or more than 2 hours duration of bypass time. The results are as follows: 1) There were no significant differences in postprotamine ACT among the 5 groups. 2) ACT of arterial blood was more prolonged than that of venous blood(139.85+/-4.77 vs 111.50+/-2.36 sec). 3) ACT in men was more prolonged than in women(638.81+/-32.10 vs 559.08+/-14.33 sec). 4) ACT in which the hematocrit value was less than 40% was more prolonged than that in which it was above 40%. 5) Although there was no difference between less and more than 2 hours duration of bypass time in ACT, additional protamine was needed in latter group.
Cardiopulmonary Bypass ; Female ; Heart Diseases ; Heart* ; Hematocrit ; Heparin* ; Humans ; Male ; Thoracic Surgery*

Fourty one cases with coronary occlusive disease were anesthetised for aortocoronary bypass graft from May 1977 to December 1983 st Severance Hospital, Yonsei University Medical Center. The main anesthetic agents were diazepam-morphine-pancuronium-O2-N2O in most cases, and supplemented with halothane, enflurane of methoxyflurane in some cases. Nitroglycerin, nitroprusside, triflupromasine, and dopamine were used for keeping the hemodynamic stability before, during and after anesthesia depending on the needs. Two operative death occured in our early years. The mortality rate was 4.87% and no late deaths. The overall anesthetic management for aortocoronary bypass graft surgery is disscussed.
Academic Medical Centers ; Anesthesia* ; Anesthetics ; Coronary Artery Bypass ; Dopamine ; Enflurane ; Halothane ; Hemodynamics ; Methoxyflurane ; Mortality ; Nitroglycerin ; Nitroprusside ; Transplants*

PURPOSE: The favorable types of the breast cancer - medullary, mucinous, papillary and tubular carcinoma are uncommon subtypes and their incidences in different series ranges between 2.0% and 8.0%, 1% and 2%, 0.3% and 3%, less than 2% of all breast cancers, respectively. In westem countries these subtypes have been reported to have good prognosis and slow growth rate. Clinically, these tumors have lower frequency of axillary nodal involvement and better 5-year or 10-year surviral rate than the other common types of breast cancer. MATERIALS AND METHODS: To determine the clinical characteristics and to evaluate the correlation between the progrostic factors and survival rate of these tumors, the medical records of 83 women with medullary, mucinous, papillary and tubular carcinoma treated at Korea Cancer Center Hospital between Jan. 1987 and Dec. 1997 were reviewed retrospectively. RESULTS: The incidences of medullary, mucinous, papillary and tubular carcinoma were 0.51%, 1.45%, 0.71% and 0.14% of all breast cancer, respectively. There were 1 case of local recurrence and 5 cases of systemic relapse during the follow-up (median follow-up peroid of 56 months). Overall 5-year survival and 10-year survival rate were 98.5% and 94.2%, respectively. No significant difference in overall survival rate was detected according to histologic types of these tumors but disease-free survival was significantly lower in papillary carcinoma than the other types of these tumors (p=0.042). Standard prognostic factors of breast cancer such as tumor size, lymph node status, age of the patient and ER status did not affect the prognosis of these tumors. CONCLUSION: Medullary, mucinous, papillary and tubular carcinoma revealed very excellent prognosis in this study regardless of tumor size, lymph node status, age of the patients and ER status.
Adenocarcinoma* ; Breast Neoplasms* ; Breast* ; Carcinoma, Papillary ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lymph Nodes ; Medical Records ; Mucins* ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

BACKGROUNDS: BCT (breast conserving therapy) is now accepted as one of the standard therapeutic options for stage I, II breast cancers. However, especially in Korean breast cancer patients, many questions still remain to be answered in terms of the optimal indication, the extent of resection and the frequency and proper management of recurrence due to the lack of studies involving large numbers of patients. The aims of this study were to examine the pattern and the frequency of recurrence following BCT and to identify the risk factors of local recurrence and systemic relapse. In addition, the outcomes for the patients treated with a quadrantectomy and with a lumpectomy were compared with particular emphasis on the rate of local recurrence. METHODS: The medical records of 386 patients who underwent a BCT at Korea Cancer Center Hospital during the period from January 1986 to December 1996 were reviewed. RESULTS: Among the 386 patients, 269 (69.7%) patients underwent a quadrantectomy and 117 (30.3%) patients underwent a lumpectomy with microscopic confirmation of margin status. Level I, II axillary dissection and whole breast irradiation, including electron beam boost to tumor site, were performed routinely. The axillar and supraclavicular areas were included in the irradiation field when 4 or more positive nodes were found. Systemic treatment (CMF or CAF?tamoxifen) was done depending on the pathological stage and the hormone receptor status of the disease. During the period of follow up (median 66 months), 9 cases (2.3%) of local recurrence and 18 cases (4.7%) of systemic relapse were identified in 24 (6.2%) patients. Between the quadrantectomy and the lumpectomy groups, there were no significant differences in the frequencies of local recurrence (p=0.179) and systemic relapse (p=0.266). Young age (< or =40) (p=0.01) and lymph node metastsasis (p=0.0001) were proven to be risk factors of local recurrence. Large tumor size (>2cm) (p=0.03) and lymph node metastasis (p=0.003) were risk factors of systemic relapse. CONCLUSION: The rates of local recurrence were very low in both the quadrantectomy and the lumpectomy group compared with those in a Western series. These results show that a quadrantectomy or a lumpectomy with confirmation of margin status by radiation therapy can provide excellent results in terms of local control and survival in Korean breast cancer patients.
Breast Neoplasms ; Breast* ; Follow-Up Studies ; Humans ; Korea ; Lymph Nodes ; Mastectomy, Segmental ; Medical Records ; Neoplasm Metastasis ; Recurrence* ; Risk Factors