This study aimed to evaluate the appropriateness of cataract surgery and identify the characteristics of patients and surgeons, clinical and functional outcomes, and surgical methods associated with appropriate cataract surgery. For this purpose, Korean cases of cataract surgery were rated as either 'necessity', 'appropriate', 'uncertain' or 'inappropriate', based on RAND/UCLA Ratings. For this assessment, the cases of 222 patients who underwent cataract surgery, on either one or both eyes, were studied. The surgeries were performed by 20 ophthalmologists practicing at one of fourteen medical institutions (university hospitals and general hospitals). Patients were interviewed and clinical data collected. The Doctors were questioned with self-entered questionnaire forms. The medical records were also examined to gain an understanding of the surgical process. The ratings were as follows: 30.6% (68 patients) of surgeries belonged to the bracket "necessity", 46.4% (103 patients) to "appropriate", 15.3% (34 patients) to "uncertain" and 7.7% (17 patients) to "inappropriate". In this study, "necessity" and "appropriate" were defined as "appropriate" (77.0%, 171 patients), and "uncertain" and "inappropriate" as "inappropriate" (23.0%, 51 patients). The low preoperative Snellen visual acuity and visual function, advanced age and male patients were associated with appropriate surgery. It is concluded that appropriate surgery was related to the clinical and functional outcomes (visual acuity and visual function) and patient characteristics (age and male).
Aged ; Cataract Extraction/*standards/*utilization ; Female ; Human ; Male ; Middle Aged ; *Outcome Assessment (Health Care) ; Patient Satisfaction ; Questionnaires ; Unnecessary Procedures ; Visual Acuity

Retrograde intubation has been often used in the patient who reveal difficulty intubation. But, it is time consuming procedure and the patient may be fall into hypoxemia. We have experienced a successful retrograde nasotracheal intubation without hypoxemia by using the Laryngeal Mask Airway. After induction of inhalation anesthesia, ordinary endotracheal intubation was failed in this 45-year-old male patient who was planned to clip the cerebral aneurysm, because the epiglottis could not be seen under direct laryngoscopy. We decided to perform retrograde nasotracheal intubation. Face mask was replaced with Laryngeal Mask Airway and ventilation was continued during procedure. A 18-gauge Tuohy needle was introduced through the cricothyroid membrane and then the epidural catheter was passed cephalad to larynx, distal hole of Laryngeal Mask Airway, and the end of Laryngeal Mask Airway. A 16-F Levin tube was introduced through right nasal cavity and Laryngeal Mask Airway was removed, the Levin tube was tied with epidural catheter in the oral cavity. The epidural catheter was placed from cricothyroid membrane to right nares. The endotracheal intubation was performed successfully by sliding over the catheter. In the postoperative evaluation, significant complications were not detected. The procedure was performed in about 2 minutes and the apneic time was less than 30 seconds. We believe that this procedure may be useful in the patients who may suffer from hypoxemia.
Anesthesia, Inhalation ; Anoxia ; Catheters ; Epiglottis ; Humans ; Intracranial Aneurysm ; Intubation* ; Intubation, Intratracheal ; Laryngeal Masks* ; Laryngoscopy ; Larynx ; Male ; Masks ; Membranes ; Middle Aged ; Mouth ; Nasal Cavity ; Needles ; Ventilation

BACKGROUND: This study was done to investigate the clinical risk factors of delirium in general hospital's elderly inpatients. METHODS: A case-control study design was used. Forty cases and age -sex matched 120 contols were identified using hospital discharge data from June 1995 to May 2001. The controls were selected during the same period. The clinical records of each subject were reviewed using discharged disease code to select cases. Subsequent7, the data were recorded from clinical records. RESULTS: The subjects admitted with delirium tended to have increased age (P=0.007), hypoxia(P=0.018), low hemoglobin(P =0.011),sleep disturbance (P=0.001), more ADL total dependence ( P=0.018), diagnoses with infections (P=0.006), diabetes (P=0.046), and hypertension (P=0.041). Above risk factors seemed to be clinically associated with delirium. CONSLUSION: These findings indicate that rapid infection control, maintenance of good sleep hygiene, well-controlled diabetes and hypertension, and correction of hypoxia may help to prevent delirium in general hospital's elderly inpatients.
Activities of Daily Living ; Aged* ; Anoxia ; Case-Control Studies ; Delirium* ; Diagnosis ; Humans ; Hygiene ; Hypertension ; Infection Control ; Inpatients* ; Risk Factors*

The coexistence of extraadrenal pheochromocytoma and renal artery stenosis is extremely rare. The mechanisms of renal artery stenosis with pheochromocytoma include direct compression of the tumor mass on the renal artery and catecholamine-induced vasospasm, fibromuscular hyperplasia, and fibrous adhesion. We report a rare case of renal artery stenosis caused by extraadrenal pheochromocytoma in a 29- year-old female. She was admitted to the hospital because of palpitation and headache. She had been treated for hypertension for 2 years. On admission, her plasma epinephrine and norepinephrine levels were elevated as were her plasma renin activity, urinary vanillylmandelic acid (VMA) and metanephrine levels. Through the use of abdominal computed tomography, 131I-MIBG scan, and renal arteriography, a mass was found in the hilus of the left kidney which affected left renal artery stenosis. Surgical removal of the mass and left kidney restored the catecholamine excretion, plasma renin activity, and blood pressure to normal. Electronmicroscopic examination of the mass confirmed the pheochromocytoma.
Angiography ; Blood Pressure ; Epinephrine ; Female ; Headache ; Humans ; Hyperplasia ; Hypertension ; Kidney ; Metanephrine ; Norepinephrine ; Pheochromocytoma* ; Plasma ; Renal Artery Obstruction* ; Renal Artery* ; Renin ; Vanilmandelic Acid

BACKGROUND: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. METHODS: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. RESULTS: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder (8.2 +/- 7.9 mm versus 7.3 +/- 3.4 mm, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. CONCLUSIONS: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.
Arm ; Clavicle* ; Consensus ; Elbow ; Extremities ; Hand ; Humans ; Ligaments* ; Prospective Studies ; Seoul ; Shoulder ; Shoulder Fractures ; Skin ; Suture Anchors ; Sutures*

PURPOSE: To compare the accuracy of implantation by radiologic results between 3D Linker and navigation guided total knee arthroplasty. MATERIALS AND METHODS: Between February 2004 and April 2005, total knee arthroplasties were done in 25 knees with balanced gap-resection technique (group A) and 25 using kinematic navigation system(group B) by a single surgeon. All patients had standing long anteroposterior (AP) radiographs of the lower extremities and supine lateral radiographs of the knees at 6 weeks postoperatively. Mechanical axis deviation, alpha and beta, angles were measured on standing long leg AP views and alpha and beta angles on supine knee lateral views. Results were classified according to the deviation from the reference line and graded as excellent, good, and poor. The result was regarded as satisfactory when all five angles were excellent or good. RESULTS: The mean mechanical axis deviation was 1.11degrees in group A and 1.36degrees in group B and all were excellent in both groups. Regarding alpha.angles, 19 cases were excellent and, 6 good in group A and, 21 excellent and 4 good in group B. Regarding., angles, 22 cases were excellent and, 3 good in group A and, 23 excellent and 2 good in group B. Regarding.,, angles, 15 cases were excellent, 8 good and 2 poor in group A and, 15 excellent, 9 good, and 1 poor in group B. Regarding beta angles, 19 cases were excellent, 3 good and 3 poor in group A and, 23 excellent, and 2 poor in group B. There were no statistical differences between two groups in all five angles (p>0.05). An excellent implantation in all five angles was obtained in 28% in group A and 60% in group B (p<0.05). There were 80% of satisfactory cases in group A and 84% in group B with no statistical difference (p>0.05). CONCLUSION: Radiological results (mechanical axis and component angles) of total knee arthroplasty were satisfactory in 80% with balanced gap-resection technique and 84% with kinematic navigation system and showed no statistical difference.
Arthroplasty* ; Axis, Cervical Vertebra ; Humans ; Knee* ; Leg ; Lower Extremity

OBJECTIVES: To compare eating behavior according to the shift work and to find the factors associated with the abnormal eating behavior in university hospital's nurses. METHODS: For this assessment, a cross-sectional study was conducted with 300 university hospital's nurses. Nurses were questioned with self-reported questionnaire forms. After excluding cases with incomplete data, 276 cases are enrolled in the study. To find the factors associated with the abnormal eating behavior, we conducted multiple logistic regression analysis. RESULTS: The proportions of shift work nurses were 63.77%(176 cases). The proportions of abnormal eating behavior among shift work nurses were 22.73%(40 cases), but only 6.00%(6 cases) among non-shift work nurses had the abnormal eating behavior. Considering the shift work period, the proportions of abnormal eating behavior were 31.25%, 22.92% and 17.50% in case of shift work period were less than 1 year, 1~3 years and more than 3 years, respectively. The abnormal eating behavior was associated with having shift work, doing exercise, more weekly working hours, being on a diet and having perception of overweight. But age and body mass index were not influenced the abnormal eating behavior. CONCLUSIONS: In this study, we found that the factors associated with the abnormal eating behavior are the shift work, exercise, weekly working hours, perception of overweight and diet.
Body Mass Index ; Cross-Sectional Studies ; Diet ; Eating* ; Feeding Behavior* ; Logistic Models ; Overweight ; Surveys and Questionnaires

It is clinically important to know the size of normal trachea for airway management and respiratory care. The knowledge is useful for avoiding many possible complications due to tracheal intubation by appropriate choice of endotracheal tube size. Therefore, we investigated antero-posterior(A-P) diameter, transverse diameter and cross- sectional area(CSA) of trachea at various level with MRI(magnetic resonance imaging) in 70 males and 79 females who were divided into three age groups(group 1: 16-39 year of age, group 2: 40-59 year of age, group 3: 60-83 year of age), and they had no abnormalities in cardiopulmonary system. The results were as follows; 1. A-P 2. Transverse 3. Narrowing portion 4. CSA 1. A-P diameter of trachea was 17.1+/-1.4 mm in male and 13.9+/-1.3 mm in female. Transverse diameter of trachea was 15.1+/-1.6 mm in male and 13.3+/-1.5 mm in female(Table 1). A-P and Transverse diameters were greater in male than in female (P<0.05). 2. C-7 was the narrowest portion of A-P diameter in both sex (P<0,05). C-5 was the narro- west portion of transverse diameter in both sex (P<0.05). 3. A-P diameters of trachea among male patients were 17.1+/-1.2 mm, 17.41.6 mm, and 16.6+/- 1.3 mm in group 1, 2 and 3 (Table 3, Fig. 4). A-P diameters of trachea in female age group 1, group 2 and group 3 were 13.7+/-1.2 mm, 14.3+/-1.3 mm, and 13.6+/-1.5 mm(Table 3, Fig. 4). Transverse diameters of trachea in male age group 1, group 2 and group 3 were 14.8+/-1.4 mm, 15.1+/-1.7 mm, and 15.4+/-1.6 mm(Table 3, Fig. 4). Transverse diameters of trachea in female age group 1, group 2 and group 3 were 13.0+/- 1.2 mm, 13.6+/-1.9 mm and 13.5+/-1.4 mm(Table 3, Fig. 4). 4. CSA(cross sectional area) of trachea were 201.1+/-31.3 mm(2) in male and 145.4+/-27.7(2) mm in female(Table 4). 5. CSA at C5, C6, C7 and Tl in male were 175.9+/-61.1 mm(2), 201.1+/-43.8 mm(2), 196.2+/-36.2 mm(2) and 230.9+/-463 mm(2) (Table 4, Fig. 5). CSA at C5, C6, C7 and Tl in female were 127.0+/- 33.4 mm(2), 138.434.6 mm(2), 140.734.7 mm(2) and 171.7+/-42.0 mm(2) (Table 4, Fig. 5). 6. CSA of trachea among male patients were 198.1+/-28,5 mm(2), 206.2+/-33.0 mm(2) and 198.3+/-33.1 mm(2) in group 1, 2 and 3 (Table 5, Fig. 6). CSA of trachea in female age group 1, group 2 and group. 3 were 140.2+/-25.0 mm(2), 152.8+/-32.4 mm(2) and 145.6+/-25.1 mm(2) (Table 5, Fig. 6). But there was no significant difference between groups according to the sex. 7. CSA of trachea in age groups were stastically insignificant for both sex.
Adult* ; Airway Management ; Female ; Humans ; Intubation ; Magnetic Resonance Imaging* ; Male ; Trachea*

While anomalies of the pancreaticobiliary system are not uncommon, drainage of the common bile duct into the bulb of the duodenum has rarely been reported. The awareness of ectopic drainage of the CBD is stressed to prevent surgical damage and improve medical management in this area. We reported one case of anomalous drainage of the CBD and pancreatic duct associated with nonvisible gallbladder or agenesis of gallbladder and cystic duct diagnosed by ERCP, ultrasonography and upper abdominal CT.
Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Cystic Duct ; Drainage* ; Duodenum ; Gallbladder ; Pancreatic Ducts* ; Tomography, X-Ray Computed ; Ultrasonography

While anomalies of the pancreaticobiliary system are not uncommon, drainage of the common bile duct into the bulb of the duodenum has rarely been reported. The awareness of ectopic drainage of the CBD is stressed to prevent surgical damage and improve medical management in this area. We reported one case of anomalous drainage of the CBD and pancreatic duct associated with nonvisible gallbladder or agenesis of gallbladder and cystic duct diagnosed by ERCP, ultrasonography and upper abdominal CT.
Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Cystic Duct ; Drainage* ; Duodenum ; Gallbladder ; Pancreatic Ducts* ; Tomography, X-Ray Computed ; Ultrasonography