The distal tibial physeal plate is the second most frequently injured physis and the percentile incidence of its injury is reported to reach 11 percent of all physeal injuries. After physeal injuries, many complications may follow such as angulatory deformity, incongruity of the joint surface, and growth disturbance, which are well recognized. Therefore, for preventing these complications, we have to know mechanism of injury and position of foot in injury. There are several published articles about classification of these injuries. The first traumatological classification of ankle injuries in children is the one proposed by Bishop. Although there were many reports about classification since Bishop, those did not mention the position of foot in injury. Recently a modified classification by Dias and Tachdjian added the postiton of the foot during injury to the direction of the force as Lauge-Hansen did. There were only few reports about epiphyseal and physeal injuries of the ankle in Korea. Also, we could not find the reports which dealt with more than forty cases. The authors have made a clinical analysis on forty cases of childrens ankle fractures, and among them twenty-two could be followed over a year, who were treated at the Department of Orthopaedic Surgery, Kang-Nam St. Marys Hospital, from June 1981 to December 1986. Children were in age of 3 to 16 years. Forty cases were classified according to modified Dias and Tachdjians. 15 out of 40 cases (37.5%) had supination and external rotation injury, which is the most frequent mechanism of injury in this series. However, one case (2.5%) which was suspected to be axial compression type could not be accommodated to this classification. Twenty-seven cases were treated by gentle closed reduction and immobillization in a plaster cast, and thirteen by open reduction and internal fixation. Among the 22 cases who were followed over a year, five cases had complications, such as angulatory deformity, incongruity of the joint surface, and growth disturbance. Three cases out of these five cases had incongruity of the joint surface.
Ankle Fractures ; Ankle Injuries ; Ankle ; Casts, Surgical ; Child ; Classification ; Congenital Abnormalities ; Foot ; Humans ; Incidence ; Joints ; Korea ; Supination

We have attempted to define the acetabular remodelling after varus derotation osteotomy and limitations of pelvic osteotomy in the treatment of DDH. We studied the case of thirty eight patients (42 hips) who were divided into three groups according to age at operation and into two groups, subluxation with acetabular dyaplasia and complete dislocation. The cases were evaluated the influence of femoral remodeling, age, acetabular response and instability and requirement of other additional surgery. The length of follow up ranged from two to fourteen years. A return to a valgus femoral neck shaft angle by remodeling was observed in case without avascular necrosis of femoral head. Acetabular correction by remodeling occurred in case of well reduced the femoral head in the socket. Acetabular remodeling was observed even in age of 8. Twenty eight of 42 hips which were complete dislocation required no pelvic osteotomy. A varus derotation osteotomy is a necessary procedure for hip stability and open reduction in treatment of DDH. Good results should be anticipated in patient whose femoral head was well seated in the acetablum.
Acetabulum ; Dislocations ; Femur Neck ; Follow-Up Studies ; Head ; Hip ; Humans ; Necrosis ; Osteotomy

PURPOSE: This study was done to determine the effects of walking exercise training(WET) on metabolic syndrome risk factors and body composition in obese middle school girls. METHOD: A non-equivalent pretest-posttest experimental design was used. Twenty seven subjects participated in this study from one women's middle school in Busan. The participants were purposely allocated to an experimental group (n=14) and a control group (n=13). The experimental group participated in 30-60 minutes of WET with 55 to 75% of a maximal heart rate six days a week for 12 weeks. RESULTS: The prevalence of individual risk factors on metabolic syndrome were improved in the experimental group after the intervention. The high waist circumference(WC), high triglyceride(TG), low high density lipoprotein cholesterol(HDL-C), high blood pressure(BP) and high fasting glucose(FG) were 21.4, 21.4, 14.3, 28.6 and 7.2%, respectively. There were significant differences in WC (F=22.24, p<.001), TG (F=5.34, p=0.30), body weight(F=21.99, p<.001), fat mass(F=19.17, p<.001), and % body fat(F=17.93, p<.001) between the experimental and control group after the intervention. However, there were no significant differences in HDL-C, FG and BP between the experimental and control group after the intervention. CONCLUSION: These results indicate that WET is effective in decreasing risk factors of the metabolic syndrome and body composition components in obese middle school girls. These findings suggest that WET can be useful as a nursing intervention in the prevention of obesity-related disorders in obese adolescents.
*Walking ; Risk Factors ; Obesity/*rehabilitation ; Metabolic Syndrome X/*blood/prevention & control ; Lipids/blood ; Humans ; Female ; *Exercise ; *Body Composition ; Blood Pressure ; Blood Glucose/analysis ; Adolescent

PURPOSE: The purpose of this study was to analyze teaching status and knowledge about children with Attention Deficit Hyperactivity Disorder (ADHD) in elementary school teachers. METHODS: The participants of this study were 204 elementary school teachers in Busan. From July to September 2010, the researchers collected data by using self-report questionnaires consisted of questions about their teachers' characteristics and teaching status and KADDS (36 items) developed by Sciutto, Terjesen and Frank. Frequency, percentage, arithmetic mean, standard deviation, t-test and ANOVA were used to analyze the data using SPSS WIN 16.0 program. RESULTS: Less than 50% of the participants had previous education on ADHD. According to this experience, there were significant differences in participants' knowledge about children with ADHD (t=4.703, p<.001). For the 36 items, participants had an average of 19.19+/-4.58 points out of a possible 36. Moreover, lack of knowledge about teaching children with ADHD and communication problems with the parents of these children were considered to be the most disturbing factors. CONCLUSION: These results suggest that networks among teachers, parents and medical care professionals should be established. The results also indicate that educational programs for elementary school teachers should be developed in order to identify and teach children with ADHD appropriately.
Attention Deficit Disorder with Hyperactivity ; Child ; Humans ; Parents ; Child Health ; Surveys and Questionnaires

Slipped capital femoral epiphysis is a rare disease in Korea, but the incidence has being increased according to the changes of body contour and life style. Now we have more concern about slipped capital femoral epiphysis, especially the factors which contribute to the final result of treatment. Many factors such as severity of slip, stability of slipped epiphysis, whether closed reduction was done or not, whether severe complication like avascular necrosis or chondrolysis has occurred or not have effect on the result. We analyzed 20 cases of slipped capital femoral epiphysis, which occurred in 16 adolescence in view of which factors contributed to the final satisfactory result. In our study, the difference in the duration of symptoms, instability of slipped epiphysis, patients age, association with obesity or acute trauma and the number of pins had much effect on the final results and whether the reduction was done or not, the kinds of pins and association with endocrinopathy made a little difference. But further studies are necessary because the number of cases is not sufficient and the length of follow up period is not long.
Adolescent ; Epiphyses ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Life Style ; Necrosis ; Obesity ; Rare Diseases ; Slipped Capital Femoral Epiphyses*

Among patients scheduled for elective surgery at the Kyung Hee University Hospital, 15 patients undergoing open thoracotomy were selected. Two different ventilatory modes were employed and compared to the one-lung ventilation(control). First, 10 cmH2O of continuous positive airway pressure was applied to the unventilated lung while patients were under one lung ventilation with 50% oxygen(CPAP 10 cmH2O). Second, 10 cmH2O of positive end expiratory pressure to the ventilated lung and 10 cmH2O of continuous positive airway pressure to the unventilated lung were applied while patients were under one lung ventilation with 50% oxygen(CPAP/PEEP). Arterial oxygen tension, alveolar-arterial oxygen difference (A-aDO2) and intrapulmonary shunt fraction of two different ventilatory modes were observed and compared to control group, and CPAP/PEEP group to CPAP 10 cmHO group. The RESULTs were as followed: 1) Mean PaO2 in CPAP 10 cmH2O and CPAP/PEEP were 138+/-42 mmHg and 177+/-44 mmHg, respectively, and were significantly increased as compared to 100+/-29 mmHg of control group(P<0.05). Comparing the PaO2 of CPAP 10 cmH2O and CPAP/PEEP, there was statistically significant increase in CPAP/PEEP(P<0.05). 2) A-aDO2 in CPAP 10 cmH2O and CPAP/PEEP were 175+/-43 mmHg and 131+42 mmHg, respectively, and were significantly decreased as compared to 213+/-32 mmHg of control group(P<0.05). Shunt percentages(Qsp/QT) were measured as 23.7+/-5.8% in control group, 18.3+/-6.0% in CPAP 10 cmH2O, 13.0+/-4.3% in CPAP/PEEP. Shunt percentages of CPAP 10 cmH2O and CPAP/PEEP were decreased significantly as compared to the control group(P<0.05). Comparing the A-a DO2 and the shunt percentages of CPAP 10 cmH2O and CPAP/PEEP, there was statistically significant decrease in CPAP/PEEP(P<0.05). Based on the above RESULTs, the application of appropriate continuous positive airway pressure to the unventilated lung and 10 cmH2O of positive end expiratory pressure to the ventilated lung during one lung ventilation is thought to be more effective than only continuous positive airway pressure to the unventilated lung in preventing hypoxemia.
Anoxia ; Continuous Positive Airway Pressure ; Humans ; Lung ; One-Lung Ventilation* ; Oxygen* ; Positive-Pressure Respiration ; Thoracotomy

BACKGROUND: This study aimed at identifying the effects of improved methods of endotracheal suction and hand washing on incidence of nosocomial pneumonia (NP) in the neurosurgical ICU. METHOD: Repeated training of nurses about hand washing and adherence of the single use of suction catheter and sterile normal saline of endotracheal suction was provided. Then hand washing compliance of nurses before and after training was investigated. and the incidence of NP in all patients hospitalized for more than 72 hours in the neurosurgical ICU was investigated from Sep 1, 2000 to Jan 31, 2001 (2nd surveillance). The NP rate of that period was compared with the incidence of the 1st surveillance period, from Sep 1, 1999 to Jan 31, 2000. The data were analyzed with chi-square-test. Fisher's exact test and logistic regression analysis by SAS 8.0. RESULT: The proportion of hand washing performance increased from 15.6% to 46.8%. The rates of NP per patient during 1st surveillance and 2nd surveillance were 10.3%, 3.9%(p=0.01) patient-days rates of NP were 10.0 cases/1,000 patient days, 4.1 cases/1,000 patient days(p=0.04), and ventilator-days rates of NP were 67.6 cases/1.000 ventilator days, 16.2 cases/1,000 ventilator days(p=0.00) respectively. Out of 29 isolates, 18 were methicillin-resistant Staphylococcus aureus, which was the most frequently isolated microorganism. The risk factors associated with incidence of NP were age, length of stay, Glasgow coma scale, diabetes mellitus, duration of intubation, insertion of endotracheal tube, duration of tracheostomy, presence of tracheostomy, duration of ventilator, use of ventilator, and insertion of nasogastric tube. CONCLUSION: These results showed that single use of suction catheters and sterile normal saline and increased compliance of hand washing were important factors to decrease the incidence of NP.
Catheters ; Compliance ; Diabetes Mellitus ; Glasgow Coma Scale ; Hand Disinfection* ; Hand* ; Humans ; Incidence* ; Intensive Care Units* ; Critical Care* ; Intubation ; Length of Stay ; Logistic Models ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia* ; Risk Factors ; Suction* ; Tracheostomy ; Ventilators, Mechanical

PURPOSE: Burch colposuspension has been used for the treatment of stress urinary incontinence (SUI) with effectiveness. The purpose of this retrospective study was to compare the efficacy among abdominal, transvaginal and laparoscopic Burch colposuspension. We also compared the clinical course and complications after each procedure. MATERIALS AND METHODS: Sixty seven patients underwent Burch colposuspension were evaluated according to their approach methods. All patients were assessed for detailed history, physical examination, urodynamic study, transperineal ultrasonography, operative time, catheter indwelling period, hospital stays, success rate, and complications. RESULTS: The success rates of abdominal, transvaginal and laparoscopic Burch were 90, 86 and 76% respectively, at 26 months follow up. There was no significant complication except for a case of bladder injury in the laparoscopy group. Laparoscopic Burch operation had advantages of less invasive approach, less morbidity, shorter hospital stays and provided successful outcomes in patients with stress urinary incontinence. CONCLUSIONS: With these results, we could conclude that open, transvaginal or laparoscopic Burch operations were effective and safe for SUI with no significant differences of efficacy according to approach methods.
Catheters ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Physical Examination ; Retrospective Studies ; Ultrasonography ; Urinary Bladder ; Urinary Incontinence ; Urodynamics

Among the erythrocyte membrane defects, hereditary spherocytosis is the most common. The erythrocyte membrane defect results from a deficiency of spectrin, the most important structural protein in red cell. Hereditary spherocytosis often presents with hemolytic anemia, jaundice, moderate splenomegaly. Diagnosis is established by the presence of spherocytes in the peripheral blood, reticulocytosis, an increased osmotic fragility, and a negative Coombs test. In children, splenectomy is usually performed after age 6 years but can be done at a younger age if warranted by the severity of the anemia and the need for frequent transfusions. In the period December 1987 to Agust 1993, 9 patients with hereditrary spherocytosis underwent splenectomy and the following results were obtained. 1. Nine patients were comprised of five males and four females. 2. Five patients(55.6%) had been admitted to our hospital during age 6-10 years. 3. Four of the nine patients had autosomal dominant inheritance with variable expression. The other five patients had no known inheritance. 4. The diagnosis of the spherocytosis was based on the increased osmotic fragility and increased autohemolysis of the erythrocytes, as well as on the appearance of spherocytes in the peripheral blood smear. 5. In all cases splenectomy was performed. Two patients had concomitant gall stones and choledocholithiasis, respectively. One patient with concomitant gall stones underwent simultaneous cholecystectomy and splenectomy. The other patients associated with choledocholithiasis underwent splenectomy, cholecystectomy, choledocholithotomy, and T-tube drainage. 6. Complete hematologic recovery was obtained by the splenectomy in all cases. 7. Postoperative complication was not occurred.
Anemia ; Anemia, Hemolytic ; Child ; Cholecystectomy ; Choledocholithiasis ; Coombs Test ; Diagnosis ; Drainage ; Erythrocyte Membrane ; Erythrocytes ; Female ; Gallstones ; Humans ; Jaundice ; Male ; Osmotic Fragility ; Postoperative Complications ; Reticulocytosis ; Spectrin ; Spherocytes ; Splenectomy* ; Splenomegaly ; Wills

PURPOSE: The purpose of this study was to investigate knowledge related to child obesity of child daycare center workers. METHODS: The participants in this study were 360 child daycare center workers in 2 cities in South Gyeongsang Province. Data were collected from February to June, 2011, using self-report questionnaires including questions about the general characteristics of the daycare center workers and their knowledge related to child obesity. Frequency, percentage, arithmetic mean, standard deviation, t-test and ANOVA were used to analyze the data with the SPSS WIN 16.0 program. RESULTS: The knowledge scores of child daycare center workers about child obesity averaged 74.8. The domains of diet (0.87 points) and prevention (0.86 points) had high scores, while, the domains of general characteristics (0.64 points) and diagnosis (0.59 points) had low scores. CONCLUSION: These results indicate that obese education programs for child daycare center workers should be developed in order to identify and teach children with obesity appropriately.
Child ; Child Day Care Centers ; Diet ; Humans ; Obesity ; Child Health ; Surveys and Questionnaires