Dislocation of both ends of a clavicle in a 49-yesr-old man during an auto-accident is presented. The medial end of the right clavicle was severely displaced antero-inferiorly while the 1ateral end displaced posteriorly. And the clavicle was rotated along its long axis. Sever al attempts of manual and a surgical reduction through separate incision on both ends of the clavicle failed to have anatomical reduction. It was presumed that the cause of failure in reduction were delayed reduction due to combined chest injury, blockade by first rib that was broken and was anteriorly displaced as well as the complexity of the dislocation. It is speculsted that anatomic reduction in this rare injury require wider surgical exposure. Though authors failed to have anatomic reduction in present case, stabilization of the medial end of the clavicle with a strip of fascia lata after medial clavicular resection and ligament repair at the lateral end resulted in satisfactory regain of shoulder motion and cosmetic improvement.
Clavicle ; Dislocations ; Fascia Lata ; Ligaments ; Ribs ; Shoulder ; Thoracic Injuries

No abstract available.
Asthma*

PURPOSE: This study was done to examine perioperative nurses' perception of the definitions and causes of nursing errors; the relationships among emotional distress, coping strategies, and changes in practice as a result of errors. METHODS: A descriptive, correlative design was used with a sample of 146 nurses working in the operating room of a university hospital. Data were collected using a self-report questionnaire with 4 point Likert scales. For the analysis, t-test, ANOVA, Scheffe's post hoc test and multiple regression analysis were used. RESULTS: Most nurses recognized themajority of the items as perioperative nursing errors. Job overload was perceived as the cause of errors. Emotional distress was significantly related with nurses' age, position and years of work experience. The coping strategies used most frequently were 'accepting responsibility' and 'planful problem solving'. The coping strategies of 'accepting responsibility', 'planful problem solving', 'seeking social support', and 'using self-control' were significant predictors in constructive practice change. Defensive changes were related to the strategy of escape/avoidance and emotional distress. CONCLUSION: The results of this study suggest that intervention strategies should be developed to decrease perioperative nurses'distress and improve their coping strategies resulting in constructive change in practice after committing an error.
Medical Errors ; Nursing* ; Operating Rooms ; Perioperative Nursing ; Surveys and Questionnaires ; Weights and Measures

Acute generalized exanthematous pustulosis(AGEP) is a disease entity caused mostly by drugs or viral infections. Clinically it manifests as generalized erythema, erythema multiforme and amicrobial pustules with fever. Histologically, AGEP is composed of neutrophilic subcorneal and spongiform pustules. A 70-year-old female, with no personal or family history of psoriasis, was given medication including diltiazem for hypertension. Fourteen days after taking the medications, pustular eruptions appeared on the face and rapidly spread to the trunk and limbs. A Laboratory examination revealed neutrophilic leukocytosis and an elevated erythrocyte sedimentation rate. The skin biopsy showed subcorneal and spongiform pustules. We report here a case of AGEP probably due to diltiazem.
Acute Generalized Exanthematous Pustulosis* ; Aged ; Biopsy ; Blood Sedimentation ; Diltiazem ; Erythema ; Erythema Multiforme ; Extremities ; Female ; Fever ; Humans ; Hypertension ; Leukocytosis ; Neutrophils ; Psoriasis ; Skin

Seventeen patients with classical rheumatoid arthritis have been treated with gold sodium thiomalate(G.S.T) injection and followed up for 1.7 years on average. The results obtained are as follows: 1. Clinical improvement was obtained in 12(70.3%) out of 17 cases, but only in 5 cases(29.3%) marked and persisting improvement was obtained. Such improvement was first noticed when the total dose of the gold sodium thiomalate reached 500mg or more, and also noticed about 10 weeks after initiation of G.S.T therapy. 2. Changes in laboratory parameters such as hemoglobin, hematocrit, eosinophilia, titers of rheumatoid factor and C-reactive protein, and proteinuria began to appear at the time of the clinical improvement. 3. Adverse reaction consisted mostly of mucocutaneous lesions. The main causes of drop-out during therapy also are severe skin rashes and pruritus. Most of the adverse reactions appeared when the total dose of G.S.T. administered reached over 500mg. In two severe cases skin rashes terminated the gold therapy. Our findings suggest, because of high incidence of adverse reaction during G.S.T therapy, repeated careful clinical and laboratory examination of the patient are mandatory especially when the total dose of G.S.T is reached 500mg. In spite of the well documented reports of the maintenance gold therapy for rheumatoid arthritis it is felt that the maintenance gold therapy should be studied further before it can be safely used as a routine in daily rheumatology practice because of its toxicity.
Arthritis ; Arthritis, Rheumatoid ; C-Reactive Protein ; Eosinophilia ; Exanthema ; Gold Sodium Thiomalate ; Hematocrit ; Humans ; Incidence ; Proteinuria ; Pruritus ; Rheumatoid Factor ; Rheumatology ; Sodium

The purpose of this study was to assess and compare the osseous responses to implanted particles of porous synthetic HA(Interpore 200(R), Interpore International, U.S.A.), resorbable natural bovine derived HA(Bio-oss(R), Gestlich Pharma, Switzerland) and calcium carbonate(Biocoral 450(R), Inoteb, France) in bone defects. Four calvarial defects of 2.5mm diameter were created in each of 16 Sprague-Dawley rats. The experimental materials were subsequently implanted in three defects, leaving the fourth defect for control purpose. Four animals were each sacrificed at 3 days, 1week, 2weeks and 4 weeks after surgery. The tissue response was evaluated under light microscope. Overall, histologic responses showed that all the particles were well tolerated and caused no aberrent tissue responses. There were difference in the amount of newly formed bone at the experimental sites and control site. There was more new bone formation associated with calcium carbonate site. In addition, the calcium carbonate site displayed multinucleated giant cells surrounding calcium carbonate particles after the 1st week, and osteoid tissue within the particle after the 2nd week. After 4 weeks, calcium carbonate particles were resorbed and replaced with new bone. The healing of the natural bovine derived HA site was similar to that of porous synthetic HA, except that new bone growth between the two particles have progressed more in the former site after the 2nd week. In the natural bovine derived HA site, the particle was surrounded by newly formed bone after the 4th week. After 4 weeks, the control site showed more mature bone than other sites. In conclusion, the grafted sites were better in new bone formation than non-grafted sites. In particular the calcium carbonate site showed the ability of osteoinduction and natural bovine derived HA showed osteoconduction in rat calvarial defects. This suggest that calcium carbonate and natural bovine derived HA could enhance the regenerative potential in periodontal defects.
Animals ; Bone Development ; Bone Regeneration ; Bone Substitutes* ; Calcium ; Calcium Carbonate ; Giant Cells ; Osteogenesis ; Rats* ; Rats, Sprague-Dawley ; Transplants

OBJECTIVE: A polymerase chain reaction (PCR) was developed in the detection of Chlamydia(C) trachomatis, Mycoplasma(M) hominis and Ureaplasma(U) urealyticum, which have been common causes of sexual transmitted diseases in the female genital tracts and in neonatal infection. To investigate tbe frequency of these organisms in the female genital tract infection and to know any association of these infections with clinical manifestations, PCR was performed. METHODS: PCR was performed in 300 cases of vaginal swabs and 154 paraffin embedded tissues including 50 cases of chronic endometritis, 50 cases of cleonic salpingitis, 50 cases of ectopic tubal pregnancy and 4 cases of normal endometrium. RESULTS: Among 300 cases of vaginal swabs, C. trachomatis, M. hominis and U. urealyticum were detected in 1.3%, 4.0%, and 29.6%, respectively. Mixed infection was found in 12.0%. the overall positive rate was 47.0%. The cytologic features from C. trachomatis, M. hominis and U. urealyticum positive patients revealed no specific findings. The clinical manifestations between positive and negative cases for these organisms had no differences. In tissue samples, only C. trachomatis was detected 2% of chronic endometritis, 8% of chronic salpingitis and 4% of ectopic tubal pregnancy. CONCLUSION: With the above results, it suggests C. trachomatis can evoke an ascending chronic infection of the female genital tracts and ectopic tubal pegnancy,
Chlamydia trachomatis* ; Chlamydia* ; Coinfection ; Endometritis ; Endometrium ; Female* ; Humans ; Mycoplasma hominis* ; Mycoplasma* ; Paraffin* ; Polymerase Chain Reaction ; Pregnancy ; Pregnancy, Tubal ; Reproductive Tract Infections* ; Salpingitis ; Ureaplasma urealyticum* ; Ureaplasma*

We investigated the role of the tumor suppressor genes in the germ cell tumor. Immunohistochemistry (IHC) and polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) for p53 mutation were done in 46 cases of the germ cell tumor with paraffin embedded tissue. The immunohistochemical staining for Rb protein was also performed in the same specimens. The following results were obtained. The overexpression of the p53 protein was detected in 7 of 46 cases (15%). p53 mutation by PCR-SSCP was detected in 1 of 46 cases (2.2%). Expression of Rb protein was negative in 19 cases (41%). These results suggest that p53 mutation does not play an important role in the initiation and progression of germ cell tumors.
Genes, Tumor Suppressor ; Germ Cells* ; Immunohistochemistry ; Neoplasms, Germ Cell and Embryonal* ; Paraffin ; Retinoblastoma Protein*

According to the Mainz classification, renal cell carcinoma (RCC) consists of three subtypes: each has characteristic genetic alterations within the chromosomal or mitochondrial DNA. The three subtypes are: clear cell type, chromophil type, and chromophobe type. E-cadherin is a Ca++-dependent adhesion molecule which plays a major role in the maintenance of intercellular adhesion in epithelial tissues. In a normal kidney, E-cadherin is expressed in the distal tubule and the collecting duct, but not in the proximal tubule. We reclassified 110 cases of RCC according to mainz classification. Immunohistochemical staining for E-cadherin was done on twenty eight cases of RCC, including 18 cases of clear cell type, four cases of chromophil type, and six cases of chromophobe type. The results were as follows: 1) of the 110 cases of RCC, 96 cases (87.3%) were of clear cell type, four cases (3.6%) of chromophil type, and ten cases (9.1%) of chromophobe type, 2) there was no significant correlation between the nuclear grade and clinical stage according to each subtype, 3) E-cadherin expression showed a strong positive reaction along the cell membranes in all six cases of chromophobe type. The differential expression of E-cadherin in RCC may suggest that the chromophobe type may have different biologic characteristics from other types of RCC.
Cadherins* ; Carcinoma, Renal Cell* ; Cell Membrane ; Classification* ; DNA, Mitochondrial ; Immunohistochemistry ; Kidney ; Population Characteristics

BACKGROUND: Psoriasis is a disabling and intractable disease influencing the psychosocial life of the patients. Patients who are frustrated with orthodox medicine may explore alternative therapies. OBJECTIVE: This study was done to research on the actual condition of the use of alternative medicine in the patients with psoriasis. METHODS: A self-administered questionnaire was constructed, and was given to the patients to answer our questions. RESULTS: Among 128 patients with psoriasis, 61 (47.7%) reported previous use of one or more forms of alternative medicine. The absence of satisfactory long-term effects of physician-provided therapy was the main reason for patients trying alternative medicine. Persons without skin s disease and the mass media were the main sources of information on alternative medicine. CONCLUSION: Alternative therapies were widely utilized by subjects participating in this study, and dermatologists need to be aware of alternative treatments employed by their patients.
Complementary Therapies* ; Humans ; Mass Media ; Psoriasis* ; Skin