No abstract available.
Ankle*

Thirty six conseutive patients with recurrent hypertensive intracerebral hemorrhage were identified in a retrospective review of 307 cases of hypertensive intracerebral hemorrhage(HICH) treated at the Fatima hospital between September, 1989, and August, 1992. The recurrence rate was 1.7%. There were 14 males and 22 females, aged 38 to 83 years. Only one patient had recieved regular antihypertensive therapy after initial hemorrhage. The mean volume of hemorrhage was 21.7cc at first attack and 19.5cc at recurrent attack. The site of recurrent hemorrhage was putamen in 18 cases, thalamus in 12 cases, cerebellum in 8 cases and lobar in 3 cases. The most common pattern of recurrence was "Ganglionic-Ganglionic"(10 cases). Recurrent hemorrhage occurred at the same side in 54.8% and same side & same wite in 16.7% of recurrent hemorrhage. Mean interval between the hemorrhage was 17.4 months and 55.8% of recurrent hemorrhage occurred within 1 year. Initial condition was worse at recurrent hemorrhage and outcome also was worse regardless of treatment methods. We concluded that recurrent intracerebral hemorrhage in HICH patients was not a rare condition and regular follow up and antihypertensive therapy was important in prevention of recurrent hypertensive intracerebral hemorrhage.
Cerebellum ; Cerebral Hemorrhage ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension ; Intracranial Hemorrhage, Hypertensive* ; Male ; Putamen ; Recurrence ; Retrospective Studies ; Thalamus

A 18-month-old child admitted with neck pain, spasm and neck motion limitation after traffic accident. On C-spine lateral view, there was anterior angulation of odontoid process with anterior displacement of atlas. Neurologic examination showed no specific focal deficits. The patient was treated with Gardner-Wells tongs traction, skeletal traction with wiring, Halo vest for 2 months, Minerva cast for 2 months and cervical collar brace. Eight months after the trauma, follow-up dynamic C-spine lateral view showed bone fusion without false movement or growth retardation.
Accidents, Traffic ; Braces ; Child* ; Follow-Up Studies ; Humans ; Infant* ; Neck ; Neck Pain ; Neurologic Examination ; Odontoid Process* ; Spasm ; Traction

Actinomycosis is an oppoturnistic infection of actinomyces, which are relatively avirulent endogenous oral commensals. After trauma or infection, they breach the normally protective mucosal barriers to invade adjacent soft tissue structures. Lesions routinely contain other bacteria, the normal resident flora at the site of primary infection, which act synergistically with actinomyces species to provoke this unique infection, which range from an acute suppurative process to a chronic fibrotic process. According to epidemic studies about pelvic actinomycosis, it should be significantly related to IUD(intrauterine device). It is accounted that IUD cause chronic intrauterine infection, tissue injury and act as nucleus for parasitic infestation. Here we present a case of pelvic actinomycosis related to IUD with brief review of the concerned literature.
Actinomyces ; Actinomycosis* ; Bacteria

Teratoma is one of germ cell tumor, common neoplasm in women of reproductive age, but it can arise at any age. Its malignant transformation is rare, less than 2%, frequently at older age. Nearly all the cases are squamous, sarcomatous and adenomatous transformation. Here we present a case of mixed transformation, adeno-squamous cell carcinoma with brief review of the concerned literature.
Carcinoma, Squamous Cell* ; Female ; Humans ; Neoplasms, Germ Cell and Embryonal ; Teratoma*

Results of 170 total knee arthroplasties(TKAs) performed from 1986 to 1995, followed up for at least one year, were reviewed. Lateral retinacular release was performed in 76 knees(45%) and not performed in 94 knees(55%). We compared the results of TKAs combined with lateral retinacular release with those without lateral retinacular release. The clinical results of TKAs were evaluated by the Knee Scoring System of Hospital for Special Surgery(HSS). The average follow-up period was 34 months. The clinical results assessed by HSS score, pain score and range of motion improved postoperatively in both groups, but there was no significant difference between the two groups. There were 8(4.7%) with patellar subluxations in 170 TKAs, one(1.3%) in the group with lateral retinacular release and 7(7.5%) in the group without lateral retinacular release(t-test; p<0.05). Analysis of lateral tilt of patella on roentgenographs also showed a significant difference between the two groups. 7 knees(9.2%) with lateral tilt were observed in the group with lateral retinacular release and 22 knees(23.4%) with lateral tilt in the group without lateral retinacular release(t-test; p<0.05). There was no osteonecrosis or fracture of patella in either group. In summary, lateral retinacular release might improve the patellar tracking and lower the incidence of patellar subluxation and lateral tilt of patella. Lateral retinacular release alone did not seem to cause patellar osteonecrosis and subsequent patellar fracture which were detectable in plain roentgenographs. So, we suggest that lateral retinacular release can be performed without great risk of potential patellar complications in TKAs requiring lateral retinacular release for proper patellar tracking.
Arthroplasty* ; Follow-Up Studies ; Incidence ; Knee* ; Osteonecrosis ; Patella ; Range of Motion, Articular

No abstract available.
Aneurysm* ; Angiography* ; Circle of Willis*

Backgrounds: End-tidal CO2 (PETCO2) monitoring is becoming one of essential respiratory monitoring systems during anesthesia. In this study, the differences between PETCO2 values measured from the 4 different sites were evaluated. METHODS: Healthy adult patients were studied (n=30). During N2O-O2-Enflurane anesthesia, PETCO2 was measured from the 4 possible monitoring sites, 3 from the breathing circuit and 1 from the monitoring lumen site of the specialized endotracheal tube connected to the distal endotracheal tube. After intubation, repeated PETCO2 measurements at 15mins (T15), 30mins (T30), 60mins (T60) and 90mins (T90) and ABGAs at T30 and T90 were done and the differences between arterial Pco2 and PETCO2 (P (a-ET)CO2) were calculated. In addition, to study the effect of changing fresh gas flow rate upon the PETCO2 values, PETCO2 measurements were done by varying the total gas flow rate from 4 L/min to 2 L/min to 6 L/min at T60. RESULTS: The Y-connector area (PETCO2- (1)) showed the lowest PETCO2 value, the elbow connector (PETCO2- (2)) and heat-moisture exchanger (PETCO2- (3)) areas, the intermediate, and the distal endotracheal site (PETCO2- (4)), the highest. The difference between the most proximal and distal sites was varied 2.4 to 3.0 mmHg and not statistically significant. PETCO2 values showed significant decreasing trend with time at each site (p<0.05). At T30 and T90, PaCO2 was not significantly different from PETCO2- (4) but significantly different from PETCO2- (1), (2), (3). The effect of changing fresh gas flow rate upon the amount of PETCO2 values of the different sites was not statistically significant. CONCLUSION: PaCO2 was significantly different from PETCO2 values measured from the breathing circuit sites but not significantly different from those measured from the distal endotracheal tube. It might be said that we have to pay special attention to these differences if we want to estimate real P (a-ET)CO2 difference.
Adult ; Anesthesia ; Elbow ; Humans ; Intubation ; Respiration

OBJECTIVES: To evaluate the occurrence of patient adverse events in Korean hospitals as perceived by nurses and examine the correlation between patient adverse events with the nurse practice environment at nurse and hospital level. METHODS: In total, 3096 nurses working in 60 general inpatient hospital units were included. A two-level logistic regression analysis was performed. RESULTS: At the hospital level, patient adverse events included patient falls (60.5%), nosocomial infections (51.7%), pressure sores (42.6%) and medication errors (33.3%). Among the hospital-level explanatory variables associated with the nursing practice environment, 'physician- nurse relationship' correlated with medication errors while 'education for improving quality of care' affected patient falls. CONCLUSIONS: The doctor-nurse relationship and access to education that can improve the quality of care at the hospital level may help decrease the occurrence of patient adverse events.
Accidental Falls ; Accidents, Occupational ; Adult ; Cross Infection/etiology ; Female ; Hospitals ; Humans ; Logistic Models ; Male ; Medication Errors ; Middle Aged ; Nurses/*psychology ; Odds Ratio ; Pressure Ulcer/etiology ; *Quality of Health Care ; Questionnaires

OBJECTIVES: To evaluate the occurrence of patient adverse events in Korean hospitals as perceived by nurses and examine the correlation between patient adverse events with the nurse practice environment at nurse and hospital level. METHODS: In total, 3096 nurses working in 60 general inpatient hospital units were included. A two-level logistic regression analysis was performed. RESULTS: At the hospital level, patient adverse events included patient falls (60.5%), nosocomial infections (51.7%), pressure sores (42.6%) and medication errors (33.3%). Among the hospital-level explanatory variables associated with the nursing practice environment, 'physician- nurse relationship' correlated with medication errors while 'education for improving quality of care' affected patient falls. CONCLUSIONS: The doctor-nurse relationship and access to education that can improve the quality of care at the hospital level may help decrease the occurrence of patient adverse events.
Accidental Falls ; Accidents, Occupational ; Adult ; Cross Infection/etiology ; Female ; Hospitals ; Humans ; Logistic Models ; Male ; Medication Errors ; Middle Aged ; Nurses/*psychology ; Odds Ratio ; Pressure Ulcer/etiology ; *Quality of Health Care ; Questionnaires