This study aims to find factors that affect variations in cesarean section frequency rates among OBGY clinics in Metropolitan areas. The factors include patient, medical supplier characteristics and economic factors. This study is a cross-sectional analysis using health insurance delivery claims from July to December 2000 and files of the NHIC(national health insurance corporation). Multiple regression was used to analyze the dependent variable of cesarean section frequency rate at each clinic. The results are as follows : Cesarean section frequency rate is increasing in proportion to the number of the following patients : repeated caesarean section, disproportion, obstructed labour, fetal distress, emergency caesarean section and self-employed patients. There are geographic variations as well. Cesarean section frequency rates are higher in Inchon and Gyonggi province than in Seoul. The higher number of total delivery the clinic has, the lower rate of cesarean section it has. Clinics with high frequency rates in 1999 showed higher rates the next year. Further research is required to develop evidence based delivery modes and change strategies for increasing normal delivery and activating midwife clinics.
Cesarean Section* ; Cross-Sectional Studies ; Emergencies ; Female ; Fetal Distress ; Humans ; Incheon ; Insurance, Health ; Midwifery ; Pregnancy ; Seoul ; Small-Area Analysis

No abstract available.
Blood Flow Velocity* ; Ductus Arteriosus* ; Humans ; Infant, Newborn* ; Ultrasonography*

PURPOSE: The purpose of this study was to develop nursing practice guidelines for water treatment system used in hemodialysis and to evaluate the guidelines by applying them in practice. METHOD: The first draft for the guidelines was developed based on advice and recommendations obtained from procedure review of critical literature. The draft was modified through evaluation by an expert group and pilot application to practice. The final draft was evaluated by the expert group using the AGREE instrument (Appraisal of Guidelines for Research and Evaluation). RESULTS: For the pilot test using the draft guidelines, 144 samples were collected from the water treatment system and hemodialysis machines. Results showed no bacteria. Endotoxin tests and chemical tests passed the criteria. After revision of the draft guidelines and additions to the draft guidelines, the final draft was confirmed. The quality of the final draft was evaluated by 4 experts using the AGREE instrument. The mean standard score was 76.9% for the 19 items. CONCLUSION: The clinical guidelines developed in this research can be utilized as systematic and scientific guidelines for water treatment systems used in hemodialysis. In addition, the results of the research can contribute to improving care services.
Bacteria ; Hemodiafiltration ; Renal Dialysis ; Water ; Water Purification ; Water Supply

Liver biopsies are used routinely in the assessment of graft dysfunction following liver transplantation and generally considered to be the most reliable method for the diagnosis of posttransplant complications with overlapping clinical and laboratory findings. To investigate posttransplant complications causing graft dysfunction and usefulness of liver biopsy, we analysed clinicopathologic features of 65 posttransplant liver biopsies, 2 autopsies and an explanted liver, taken from 20 patients. The frequencies of posttransplant complications were acute cellular rejection in 9 patients (45%), postoperative infection in 11 patients (55%), of which cytomegalovirus (CMV) infection and systemic invasive aspergillosis with candidiasis occured in 10 patients (50%) and 1 patient (5%), respectively. Remainders were hepatic arterial thrombosis in two (10%), primary graft dysfunction due to fatty donor liver in one (5%), and posttransplant lymphoproliferative disorder (PTLD) in two (10%). There were no chronic rejection or recurrent disease. Postoperative mortality was 25%. Histologic grade by Banff schema was well correlated with clinical parameters associated with unfavorable short term prognosis. CMV infection was associated with acute cellular rejection in 6 out of 10 patients (60%). Immunohistochemical staining for CMV was more sensitive method than CMV in situ hybridization or histologic detection of viral inclusion on tissue section. It was unique that one case of PTLD developed under the circumstances of the lowest dosage of immunosuppression and took grave outcome. Based on these results, we concluded that clinicopathologic correlation with integration of all the clinical and laboratory findings is necessary in the interpretation of accurate and early diagnosis of posttransplant liver biopsies. The interrelationship between chronic rejection and CMV infection as well as pathogenetic factors of PTLD remains to be clarified through further ongoing observation.
Aspergillosis ; Autopsy ; Biopsy* ; Candidiasis ; Cytomegalovirus ; Diagnosis ; Early Diagnosis ; Humans ; Immunosuppression ; In Situ Hybridization ; Liver Transplantation ; Liver* ; Lymphoproliferative Disorders ; Mortality ; Primary Graft Dysfunction ; Prognosis ; Thrombosis ; Tissue Donors ; Transplants

Surgeries performed for patients with coronavirus disease 2019 (COVID-19) place the medical staff at very high risk of infection. We suggest recommendations for appropriate operation preparation, anesthetic management, and infection control for COVID-19 patients in operating rooms.Current Concepts: Surgeries must be performed in an airborne infection isolation room, such as a negative-pressure operating room. It is recommended that scheduled surgeries for COVID-19 patients be postponed to an acceptable extent, with the exception of emergency cases. Moreover, the number of medical staff participating in the surgery should be minimized. Medical staffs should practice proper hand hygiene and wear an appropriate level of personal protective equipment depending on the infection risk. While performing surgery and inducing anesthesia in COVID-19 patients, endotracheal intubation should be performed by trained anesthesiologists with a video laryngoscope, preferably using high-efficiency viral filters, which can prevent contamination in the anesthesia machine. Use of disposable equipment or COVID-19 patient-specific devices is recommended to prevent the spread of infection, but instruments that require sharing among multiple patients must be thoroughly cleaned and disinfected before their use for the next patient.Discussion and Conclusion: Medical staff performing surgeries for COVID-19 patients are at very high risk of infection. Therefore, the use of appropriate personal protective equipment, high-efficiency viral filters in breathing circuits during anesthesia, and disinfection of contaminated equipment after the operation are mandatory.

Surgeries performed for patients with coronavirus disease 2019 (COVID-19) place the medical staff at very high risk of infection. We suggest recommendations for appropriate operation preparation, anesthetic management, and infection control for COVID-19 patients in operating rooms.Current Concepts: Surgeries must be performed in an airborne infection isolation room, such as a negative-pressure operating room. It is recommended that scheduled surgeries for COVID-19 patients be postponed to an acceptable extent, with the exception of emergency cases. Moreover, the number of medical staff participating in the surgery should be minimized. Medical staffs should practice proper hand hygiene and wear an appropriate level of personal protective equipment depending on the infection risk. While performing surgery and inducing anesthesia in COVID-19 patients, endotracheal intubation should be performed by trained anesthesiologists with a video laryngoscope, preferably using high-efficiency viral filters, which can prevent contamination in the anesthesia machine. Use of disposable equipment or COVID-19 patient-specific devices is recommended to prevent the spread of infection, but instruments that require sharing among multiple patients must be thoroughly cleaned and disinfected before their use for the next patient.Discussion and Conclusion: Medical staff performing surgeries for COVID-19 patients are at very high risk of infection. Therefore, the use of appropriate personal protective equipment, high-efficiency viral filters in breathing circuits during anesthesia, and disinfection of contaminated equipment after the operation are mandatory.

Extraskeletal chondromas are relatively uncommon benign cartilaginous tumors of the soft tissue and well known to pose a considerable diagnostic problem because of histological variations including the immature appearance of their tumor cells. Recently, we have experienced a case of extraskeletal chondroma mimicking benign chondroblastoma. The patient was a 47-year-old woman who complained of a painful subcutaneous swelling on the radial aspect of 4th proximal interphalangeal (PIP) joint in the left hand for 6 months. Radiologic examination of the 4th finger revealed a 1cm-sized soft tissue mass. Histologically, the tumor was characterized by a lobulated mass which was composed of dense proliferation of chondroblast-like cells admixed with a few multinucleated giant cells of osteoclastic type. However, there were focal areas of typical chondroma which showed lace-like intense calcification around the differentiated chondrocytes.
Chondroblastoma ; Chondrocytes ; Chondroma* ; Female ; Fingers ; Giant Cells ; Hand ; Humans ; Joints ; Middle Aged ; Osteoclasts

BACKGROUND: Ropivacaine closely resembles bupivacaine with propyl group substitutes for butyl group at the same position. Ropivacaine is presented as 100% S-isomer with important implication of safety and less cardiotoxic than bupivacaine. Because of this, ropivacaine is used as an epidural anesthesia. However this study was performed to evaluate clinical effects of ropivacaine for spinal anesthesia. METHODS: Thirty patients (ASA I-II) scheduled for elective lower extremity operation were randomly selected and received spinal anesthesia with 3 ml of 0.75% isobaric ropivacaine. The patients were placed in the lateral position and dura puncture was performed at the L3-4 interspace using the median or paramedian approach with a 25 G Quincke spinal needle. After spinal anesthesia, sensory block was assessed using the pin-prick test every 2 min., motor block was assessed using a four-point scale, and circulatory variables were monitored every 5 min. RESULTS: The mean sensory block level was T 8.6 and the maximum sensory block level was T4. Time needed for extremity motor block was 10.8 min. and 25 of 30 patients reached Bromage scale 3. Duration of motor and sensory block were 260.6 min. and 422.3 min. Hemodynamic changes (arterial pressure and pulse) were stable during anesthesia and complications were rare. CONCLUSIONS: We concluded that 0.75% isobaric ropivacaine was suitable for spinal anesthesia with good lower extremity sensory and motor block, and it was long-lasting without any specific complications.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, Spinal* ; Bupivacaine ; Extremities ; Hemodynamics ; Humans ; Lower Extremity* ; Needles ; Punctures

PURPOSE: The purpose of this study is to explore the experience of university students who witnessed of school violence during their formative years. METHODS: The participants in this study included 30 university students who had witnessed school violence. Analysis of the data was performed using content analysis according to Downe-Wamboldt. Data were collected from September 2015 to February 2016. RESULTS: Based on this study, there were four domains of school violence including witnessing, type of reaction, aftermath and future measures. According to the analysis, these four domains were classified into 13 variables, 32 categories and 73 significant statements. CONCLUSION: The results of this study suggest that further research is needed to develop measures to address problems that have developed for students who have witnessed school violence.
Humans ; Violence*

Lymphoid tumors of the orbit are rare, and sometimes it is not possible either clinically or histologically to differentiate between lymphoid tumor and pseudolymphoma. Some authors assert that the degree of cytologic differentiation appears to be the single most important factor for determining the prognosis of patients with orbital lymphoid lesions. However, the cytomorphologic basis is not so helpful to diagnose and classify our case, which shows some discrepancy between pathological findings and clinical and radiological findings. At first we misdiagnosed our case as orbital malignant lymphoma on the basis of cytomorphology and immunohistochemical study. But no responce to local intensive radiotherapy and the follow up study of the patient suggest orbital pseudolymphoma.
Follow-Up Studies