STUDY DESIGN: Clinical and radiographic results of spine fracutre treated with pedicle screws and hooks were reviewed. OBJECTIVES: Evaluate the efficacy of tile pedicle screw and hook for thoracolumar bursting fracture. SUMMARY OF LITERATURE REVIEW: Despite of the mechanical advantage of the pedicle screw, the metal failure in short segment fusion has been reported. A biomechanical study showed additional laminar hook increased rotational strength. MATERIALS AND METHODS: Between 1994 and 1996, seventeen patients who had a Denis type B bursting fracture of the thoracolumbar spine were treated by posterior instrumentation with pedicle screws and laminar hooks and auterior interbody fusion after partial corpectomy. They have been followed for an average of 13.4 months. RESULTS: At last follow-up, radiographs showed successful fusion of the injured spinal segment in all patient. The subsidence of grafts which were used In anterior interbody fusion was an average of 0.76mm. There was a loss of 2.6 degrees on average in the correction of the kyphosis. No patients had screw breakage or loosening. CONCLUSIONS: We concluded that posterior fixation with screws and hooks, anterior decompression by partial corpectomy, and strut-grafting in patient who had a Denis type B bursting frafture of the thoracolumbar spine yielded good radiographic and functional results.
Decompression ; Follow-Up Studies ; Humans ; Kyphosis ; Spine* ; Transplants

PURPOSE: This study examined the mediating effect of school nurses' self efficacy, which is one of the significant cognitive factors influencing cultural sensitivity, on the mutual relationships between multicultural attitude and cultural sensitivity in Korean elementary schools. METHODS: A cross-sectional descriptive survey design was used. Participants were 157 school nurses in elementary schools located in Gyeonggi-do, South Korea. The survey instruments included Teacher Multicultural Attitude Survey, Teacher Efficacy Scale, and Multicultural Sensitivity Scale. Data were analyzed using three regression equations to test the mediation model. RESULTS: The mean score of the school nurses' cultural sensitivity was relatively low. A positive correlation among multicultural attitude, self efficacy, and cultural sensitivity was noted. Self efficacy of school nurses showed a significant mediating effect on the relationships between multicultural attitude and cultural sensitivity. CONCLUSIONS: Given the meaningful influence of positive multicultural attitude on cultural sensitivity and significant mediator effect of self efficacy as a school nurse between the two variables, the strategies to cultivate a positive multicultural attitude and enhance school nurses' self efficacy in their unique role should be considered in a training program. School nurses' health care services will benefit from the improvement of cultural sensitivity toward young children from multicultural families.
Adult ; *Attitude of Health Personnel ; Cross-Sectional Studies ; *Cultural Diversity ; Humans ; Middle Aged ; Nursing Staff, Hospital/*psychology ; Republic of Korea ; *Self Efficacy ; Surveys and Questionnaires

PURPOSE: To find the experience about clients with hypertension and to help them to care for themselves in the community. METHOD: All data was collected from August 1999 to October 1999, through in-depth interviews, observation, and telephone interview with 7 participants who have been diagnosed with hypertension for 1 to 10 years. According to Strauss and Corbin's Methodology, the data was continuously coded into concepts and categories, and then new data was analyzed simultaneously by a constant comparative method. RESULTS: There are 171 concepts, and then they were grouped into 34 the lower categories and 15 to the upper categories. The course of the coping of fear in hypertensive client consisted of 6 processes. The awareness of seriousness was context, and the fear was core phenomenon about the coping experience. We also found that hypertensive clients have 3 patterns, depending on the awareness degree of seriousness and the fear about hypertension. CONCLUSION: Our nurses should recognize the importance of effective management and seriousness about hypertension, offer clients the importance of family support and the information of etiology, symptoms and signs of hypertension, and provide the correct information on hypertensive medication. We should be able to guide their fear about hypertension to positive self-management, so that they may manage their disease thoroughly and effectively.
Humans ; Hypertension ; Interviews as Topic ; Self Care

PURPOSE: This methodological study was conducted to develop and psychometrically test the Transcultural Self-efficacy scale (TCSEscale) for nurses. METHODS: Initial 41 items for the TCSE-scale were generated based on extensive literature reviews and in-depth interviews with 18 nurses who had experience in caring for foreign patients. Cultural Competence and Confidence model was used as a conceptual framework. Content validity was evaluated by an expert panel. Psychometric testing was performed with a convenience sample of 242 nurses recruited from four general hospitals in the Seoul metropolitan area and Gyeonggi-do province of South Korea. To evaluate the reliability of TCSE-scale, a test-retest reliability and an internal consistency reliability were analyzed. Construct validity, concurrent validity, criterion validity, convergent validity and discriminative validity were used to evaluate the validity. RESULTS: The 25-item TCSE-scale was found to have three subscales-Cognitive, Practical, and Affective domain-explaining 91.5% of the total variance. TCSE-scale also demonstrated a concurrent validity with the Cultural Competence Scale. Criterion-related validity was supported by known-group comparison. Reliability analysis showed an acceptable-to-high Cronbach's alpha-.88 in total, and subscales ranged from .76 to .87. The ICC was .90, indicating that the TCSE-scale has internal consistency and stability of reliability. CONCLUSION: This preliminary evaluation of the psychometric scale properties demonstrated an acceptable validity and reliability. The TCSE-scale is able to contribute to building up empirical and evidence based on data collection regarding the transcultural self-efficacy of clinical nurses. We suggest further testing of the applicability of TCSE-scale in different settings and community contexts.
Cultural Competency ; Cultural Diversity ; Data Collection ; Gyeonggi-do ; Hospitals, General ; Humans ; Korea ; Methods ; Psychometrics* ; Reproducibility of Results ; Self Efficacy ; Seoul

We performed standardized anterior-posterior radiographs of the normal ankle on 50 males and 50 females to determine the validity of current radiographic landmarks of the ankle syndesmosis separation. The average tibiofibular overlap was 6.9+/-2.1mm. The tibiofibular clear space was measured 4.1+/-0.9mm overall. The ratio of the tibiofibular overlap to the fibular width averaged 48+/-14%. Our data show that for 95% confidence intervals, the values for the syndesmosis separation are : (1) tibiofibular overlap less than 2.7mm, (2) tibiofibular clear space greater than 5.9mm, (3) tibiofibular overlap: fibular width ratio less than 24%. According to current diagnositc criterion of tibiofibular overlap under 10mm, 87% of this cohort was defined as syndesmosis separation. Other current criteria of tibiofibular clear space over 5 mm and tibiofibular overlap: fibular width ratio less than 24%, the false positivity was only 7% and 2%, respectively. Therefore the tibiofibular clear space and the tibiofibular overlap: fibular width ratio are more reliable diagnositc criteria for syndesmosis separation than the tibiofibular overlap.
Adult* ; Ankle Joint* ; Ankle* ; Cohort Studies ; Female ; Humans ; Male

Recently, devices using radiofrequency energy have been developed for arthroscopic soft tissue ablation and shrinkage. The purpose of this study was to evaluate effect of radiofrequency energy on the biomechanical competence of thermal shrinkage of anterior cruciate ligament and was to demonstrate a new approach for radiofrequency energy, applying to ligamentous tissue in a dynamic fashion. Twelve New Zealand White rabbits, were divided into two experimental groups by right and left hindlimbs. Thermal shrinkage of the anterior cruciate ligament of rabbits produced using radiofrequency energy generator(N=12, group I). And untreated control group(N=12, group II). The percent shrinkage was calculated from the change of length of anterior cruciate ligament after radiofrequency energyinduced thermal shrinkage. The maximal tensile stress and linear stiffness of anterior cruciate ligament as biomechanical competence were assessed. The results obtained were as follows: 1. In the group I the percentage of shrinkage was 29.50Fo on the average. 2. The average of maximal tensile stress to failure was 271.24 kN in group I and 283.50 kN in group II. There was no significant difference(p=0.24) in the maximal tensile stress between two groups. 3. The average of linear stiffness in group I(179.16kN/mm) was higher than that of group II(148.20kN/mm). But there was no significant difference(p=0.078) between two groups. This study shows that radiofrequency energy appears to be safe to use on therma1 shrinkage of anterior cruciate ligament, which necessitate a mechanical tensile strength.
Animals ; Anterior Cruciate Ligament* ; Hindlimb ; Ligaments ; Mental Competency ; Rabbits ; Tensile Strength

Traumatic optic neuropathy (TON) is an important cause of severe visual loss after blunt or penetrating head and facial trauma. High-dose steroids and surgical interventions have been applied in the indirect TON. However, there is no convincing evidence that results of the treatment have any strong benefits in terms of improvement of visual acuity. Nevertheless, surgical decompression should be considered in the case of a direct bony compression to the optic nerve and a progressive visual loss in indirect TON. Neurosurgeon should be aware the surgical indication, optimal timing and relevant technique for the optic canal (OC) decompression. In this review article, we will focus on the surgical approaches to the OC and how to decompress it.
Decompression ; Decompression, Surgical ; Head ; Neurosurgeons ; Optic Nerve ; Optic Nerve Injuries* ; Steroids ; Visual Acuity

PURPOSE: Axillary node involvement is the single most important prognostic variable in patients with breast cancer. If axillary lymph node status of breast cancer patients could be accurately predicted from basic clinical information and from characteristics of their primary tumors, many patients could be spared axillary lymph node dissection. With the availability of numerous histologic prognosticators and new immunochemical prognostic indicators, it is reasonable to reconsider the necessity of axillary node dissection for lesions more advanced than duct carcinoma in situ. MATERIALS AND METHODS: Six hundred fifty-six patients with Tl invasive breast cancer were evaluated. All the patients underwent axillary dissection, and the pathologic status of the nodes was known. The parameters of the primary tumor in this study were age, size, family history, tumor palpability, nuclear and histological grade, hormone receptor status, lymphatic vessel invasion (LVI), and various tumor markers (bc1-2, cathepsinD, c-erbB2, E-cadherin, p53). RESULTS: Approximately 31% of the 656 patients with Tl breast carcinoma had axillary node metastasis. Four factors were identified as significant predictors of node metastasis: age 35 or less (p=0.01), lymphatic vessel invasion (p < 0.01), tumor palpability (p=0.02), and tumor size (p<0.01). However, independent predictors of lymph node metastasis in the multivariate logistic regression analyses were tumor size (p=0.04) and LVI (p=0.03). CONCLUSION: Characteristics of the primary tumor can help assess the risk for axillary lymph node metastases in Tl breast cancer. Selected patients who have 1cm or less without lymphatic vessel invasion are considered to be at minimal risk of axillary node metastasis and might be spared routine axillary dissection.
Breast Neoplasms* ; Breast* ; Cadherins ; Carcinoma in Situ ; Humans ; Logistic Models ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Vessels ; Neoplasm Metastasis* ; Prognosis ; Biomarkers, Tumor

PURPOSE: The purpose of this study was to identify the effects on cognitive function, depression, and activities of daily living of Silver-Care-Robot Program for institutionalized elders. METHODS: This study was a nonequivalent control group pretest-posttest design. The participants were 42 institutionalized elders (17 in the experimental group and 25 in the control group). The Silver-Care-Robot Program was provided as an intervention which was conducted twice a week for 5 weeks. The Silver-Care-Robot Program is an integrated entertainment program to help the mental, emotional, and physical health of elderly people. Pre-test was conducted on the two groups, and, in order to examine the effects of intervention, a post-test was conducted after 5 weeks. RESULTS: There were significant differences in cognitive function and ADL (activities of daily living) between two groups after the program. But the difference in depression in the institutionalized elders was not statistically significant between the two groups. CONCLUSION: The Silver-Care-Robot Program should be considered as a regular program for cognitive function and activities of daily living for institutionalized elders.
*Activities of Daily Living ; Aged ; Aged, 80 and over ; *Cognition ; Depression/*physiopathology ; Female ; Homes for the Aged ; Humans ; Male ; Nursing Homes ; *Program Evaluation ; Robotics ; Surveys and Questionnaires

Primary erythromelalgia is a rare condition that's characterized by erythema, an increased skin temperature and burning pain in the extremities. The pain is often very severe, and treating erythromelalgia is frustrating and difficult. We report here on the case of a 12-year old girl with primary erythromelalgia in both lower extremities. The pain was refractory to medical treatment, but a bilateral sympathetic block with lidocaine and triamcinolone resulted in relief from the pain. Our experience with this disease demonstrates that sympathetic blocks are effective in improving the symptoms and they may be attempted on erythromelalgia patients who do not respond to other treatments, including medication and epidural blocks.
Burns ; Erythema ; Erythromelalgia ; Extremities ; Humans ; Lidocaine ; Lower Extremity ; Skin Temperature ; Triamcinolone