Aurthors have treated 77 cases of acute supp rative osteomyelitis since January 1972 until December 1979. Among them 69 patients had surgical treatment while 8 cases had antibiotic therapy only. 42 patients out of 69 surgically treated cases had fenestration operation, while 27 cases had multiple drilling operation to evacuate the bony abscess. In 15 cases Turkels bone biopsy needle was used to decompress the infected bones, and by It the abscess could be very effectively evacuated. After decompression with a Turkel needle by placing a small calibered polyethylene tube Into the lesion, the lesion was continuously irrigated with antibiotics solution. This procedure has proved to be very effective and a successful one which can easily be practised as an office procedure in the very poor and needy cases. Also when patients are seriously ill and/or other extensive surgery is not feasible, this simple procedure can easily be practised without hazard, Good end results without sequellae were abtained when early decompression with massive antiblotic therapy was instituted even by Turkel needle drainage.
Abscess ; Anti-Bacterial Agents ; Biopsy ; Decompression ; Drainage ; Humans ; Needles ; Osteomyelitis ; Polyethylene

Emphasis on healthcare during the 1990s has been to provide both optimal wellness and function with quality in a cost-effective manner. Critical Pathway was developed to meet the need to guide clients along the continuum of care and to achieve continuity of care. The purpose of this study was to develop on evaluating model of Critical Pathway practices. The topics which developed into Critical Pathway were normal delivery, repairment of cataract, cesarean section delivery, pediatric tonsillectomy and hemorrhoidectomy. The main goals set by teams were educations, improvement of process and quality of care, customer satisfaction and financial achievements. To evaluate the performace of Critical Pathway in clinical process, 13 kinds of perspective key performance indicators were selected by using Balanced Scorecard(BSC) method. The analysis method was Data Mining. Cesarean section discharge abstract data were reviewed for guidelines of model development and classification of control groups. Five kinds of Critical Pathway were developed by multidisciplinary participation by personnels of related departments, and pilot-test was performed. All the Critical Pathway was applied as standard protocols in patient s care since November, 1999. Length of stay was significantly shortened and increased patient s satisfaction in 4 case groups except pediatric tonsillectomy group. Hospital and medication cost of each patient remarkably decreased in all 5 case groups. And the improvement of process and quality of care was appeared during the Critical Pathway implementation period. These results show that new evaluation model of Critical Pathway in medical practice was an effective.
Cataract ; Cesarean Section ; Classification ; Continuity of Patient Care ; Critical Pathways* ; Data Mining ; Delivery of Health Care ; Female ; Hemorrhoidectomy ; Humans ; Length of Stay ; Pregnancy ; Tonsillectomy

For many years, the histogenesis of the granular cell tumor was controversial and this resulted in the tumor being given more than 20 synonyms. Abrikossoff, reporting on the fiist granular cell tomor, favored a muscle origin, but other authora have postulated a fibroblastic or a histiocytic origin. Recently, the concept of Schwann cell origin, supported by electron microscopic studies and immunohistochemistry of S-100 protein, has gained wider recognition. Approximately 90 cases of esophageal granular cell tumor have been reported in the literature, representing about 2% incidence of all reported granular cell tumor, In Korea, only four cases of granular cell tumors were reported in the literatures including the cases occuring in the cecum, colon, and anus until now. Recently we experienced 46-years old women with granular cell tumor of the esophagus, which might be the second case in Korean literature.
Anal Canal ; Cecum ; Colon ; Esophagus* ; Female ; Fibroblasts ; Granular Cell Tumor* ; Humans ; Immunohistochemistry ; Incidence ; Korea ; Middle Aged ; S100 Proteins

Spontaneous renal allograft rupture is an uncommon complication of renal transplantation, but it represents a life-threatening emergency that requires prompt recognition and treatment. The incidence of spontaneous renal allograft rupture is variable and range between 3.6 and 9.6 percent of all transplants. In the majority of cases the rupture is associated with acute rejection episodes and with renal vein thrombosis. Most frequently, the allograft rupture occurs within the first 2 weeks of transplantation. in addition, most ruptures reported have occurred in cadaveric renal allograft. Debate on the management of such allograft salvage versus transplant nephrectomy. It appears that the recent trend is toward performing surgical repair of the graft if the rupture is secondary to rejection and oo evidence of renal vein thrombosis ; otherwise, graft nephrectomy be done. We report a case of spontaneous renal allograft rupture due to renal vein thrombosis occurred in a 21-year-old woman 6 days after transplantation. Unusual severe localized pain, swelling over at allograft site, and hypotension, a triad frequently seen in renal allograft rupture, were present. Management by graft nephrectomy was inevitable because of the patient's downhill course.
Allografts* ; Cadaver ; Emergencies ; Female ; Humans ; Hypotension ; Incidence ; Kidney Transplantation ; Nephrectomy ; Renal Veins ; Rupture ; Rupture, Spontaneous* ; Thrombosis ; Transplants ; Young Adult

OBJECTIVE: This study aims at investigating the incidence, clinical nature and associated clinical characteristics of the clozapine-induced fever. METHODS: Retrospective review of hospital records was performed for 56 inpatients who had started to take clozapine and stayed at the hospital for four or more weeks after the initiation of clozapine treatment. RESULTS AND CONCLUSION: Clozapine-induced fever was developed in 31% of the patients. The mean peak temperature was 39degrees C and the mean duration of the fever was 3 days. Fever was developed average of 11 days after the initiation of clozapine treatment. All the patients were recovered without discontinuation of clozapine. Demographic variables, the clinical response to clozapine, other drugs administered with clozapine, and the presence of other adverse effects of clozapine were not associated with the clozapine-induced fever.
Clozapine* ; Fever* ; Hospital Records ; Humans ; Incidence* ; Inpatients ; Retrospective Studies ; Schizophrenia

For over a half centry, physicians have suspected that patients with duodenal ulcer are offered an insurance policy against gastric carcinoma. This may be used clinically so that gastric lesion in the presence of duodenal ulcer, are considered benign. However, the duodenal ulcer may coexit with gastric cancer, Although rare in incidence of coexistence of duodenal ulcer and gastric cancer, physician always should be alert in diagnosing of gastric lesion in the presence of the duodenal ulcer. Here, we present 60 years old woman with coexitence of duodenal ulcer and gastric cancer, diagnosed by endoscopy and treated surgically.
Duodenal Ulcer* ; Endoscopy ; Female ; Humans ; Incidence ; Insurance ; Middle Aged ; Stomach Neoplasms*

Cardiopulmonary bypass with moderate hypothermia and hemodilution is an extremely non- physiologic state. The stress responses to cardiopulmonary bypass were evaluated in open heart surgery by measuring the change of plasma cortisol concentration. Patients were anesthetized with fentanyl 20 ug/kg, 50% nitrous oxide in oxygen and a supplementary dose of droperidol and halothane. In each case, at the onset of cardiopulmonary bypass, the hematocrit value was reduced to 25-30% and was maintained around this level during perfusion. Moderate hypothermia was induced to 28-30 degrees C (28.9+/-1.5 degrees C). Blood samples were obtained after sternotomy, at the onset of cardiopulmonary bypass, during moderate hypothermia and after cardiopulmonary bypass. Plasma cortisol concentration was measured by radioimmunoassay technique. Compared with the pre-cardiopulmonary bypass cortisol value (11.12+/-2.19 ug/dl), plasma cortisol concentration at the onset of cardiopulmonary bypass (17.39+/-5.15 ug/dl) was significantly increased (p<0,05). And during cardiopulmonary bypass, especially during the hypothermia period, the plasma cortisol concentration (19.17+/-8.09 ug/dl) was significantly increased (p<0.05). After cardiopulmonary bypass, the plasma cortisol concentration (43.0+/-11.2 ug/dl) was significantly increased when compared with other values (p<0.05). We conclueded that the significant increase of plasma cortisol concentration is secondary to the stress response to cardiopulmonry bypass.
Cardiopulmonary Bypass* ; Droperidol ; Fentanyl ; Halothane ; Hematocrit ; Hemodilution ; Humans ; Hydrocortisone* ; Hypothermia ; Nitrous Oxide ; Oxygen ; Perfusion ; Plasma* ; Radioimmunoassay ; Sternotomy ; Thoracic Surgery

Purpose: This study investigated the impact of nurse practice environment and organizational justice on nurses’job satisfaction. Methods: We identified the factors between nursing work environment and organizational justice to job satisfaction for 189 nurses working at a general hospital in city C. Data were collected from June 1st to 15th, 2023, and analyzed using descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficients, and multiple stepwise regression, using IBM/SPSS 27.0 for the Windows program. Results: The mean job satisfaction was 3.24±0.55 points on a 5-point scale. Multiple stepwise regression revealed that the factors affecting nurses’job satisfaction included nursing foundations for quality of care (β=.26, p=.005), staffing and resource adequacy (β=.40, p<.001), collegial nurse-physician relations (β=-.24, p=.007), and distributive justice(β =.27, p<.001).These variables explained 55.0% of job satisfaction. Conclusion The research findings indicate that higher job satisfaction is associated with a better nurse practice environment and positive perceptions of organization justice. These findings indicate that it is necessary to enhance the nurse practice environment and improve organizational justice to enhance job satisfaction among nurses.

We experienced a case of malignant hyperthermia (MH) in 6-year-old boy during anesthesia induction for strabismus surgery. It has been generally reported that sevoflurane can induce the delayed onset of MH in the absence of succinylcholine. Our case of MH was elicited after about 2-3 min of sevoflurane administration with N2O, O2 and rocuronium. However, we successfully treated the patient by early recognition of his condition and administering symptomatic treatment and dantrolene.
Androstanols ; Anesthesia ; Child ; Dantrolene ; Humans ; Malignant Hyperthermia ; Methyl Ethers ; Strabismus ; Succinylcholine

Langerhans cell histiocytosis (LCH) is reported less frequently in adults than in children. The most common site of involvement in adults is the bone, accounting for 30-50% of cases. The gastrointestinal tract is very rare, accounting for approximately 2%. We present a case of Langerhans cell histiocytosis that simultaneously invaded multiple organs, including the stomach and colon, in an adult. A 37-year-old woman with no underlying disease complained of chest discomfort and a palpable right submandibular mass. A right Level II neck mass and mediastinal LN enlargement were confirmed on the pharynx and chest CT scan. Multiple subepithelial masses with central ulceration and erosion were observed in the corpus and fundus on the esophagogastroduodenoscopy and in the right colon on the colonoscopy. The histopathology findings were the same in each tissue biopsied from the stomach, colon, and right neck lymph nodes. Langerhans cells with classical reniform nuclei and prominent eosinophils invaded the normal glands, and S100 and CD1a were positive in the immunohistochemical stain. Gastrointestinal involvement of LCH in adults is rare, asymptomatic,and can involve multiple digestive organs simultaneously, so upper endoscopy and colonoscopy should be considered for a diagnosis.