In 1988, a new fascioutaneous flap, the Lateral supramalleolar flap, was introduced by Masquelet and Roman. The flap is designed on the lower third of the aspect of leg, and supplied by a cutaneous branch from the perforating branch of the peroneal artery. This perforating branch continues distally deep to the fascia along the anterior ankle and into the foot. This can be use as either proximally based rotation flap or distally based reversed pedicle island flap giving the flap an arc of rotation that allows coverage of the dorsal, lateral and plantar aspects of the foot, the posterior heel and the lower medial portion of the leg. The authors have recently used this flap for 13 cases of foot and ankle soft tissue defect reconstruction and all the cases, except two partial marginal necrosis, good postoperative course. In our opinion, this flap is useful for reconstruction of foot and ankle soft tissue defect which does not need nerve innervation. The main advantages of the flap are as follows 1. It may be a rather large flap(15×9cm2 ). 2. The pedicle is long(8cm) and easy to dissect. 3. The pivot of the pedicle is distal(sinus tarsi) and allows great local possibilities of coverage. 4. It does not require the sacrifice of a main artery.
Ankle ; Arteries ; Fascia ; Foot ; Heel ; Leg ; Necrosis ; Osteotomy ; Tibia

Nurses working with families who has a hospitalized child are aware of the complexity of the tasks and stresses they deal with new setting of environment. The challenge is to assess the family coping activity that require the most immediate intervention for the effective nursing care for child and family. This study describe the family coping inventory for the clinical guidance to identify a family coping with stressors. The purpose of this study was to look at the factors related to the family's coping activity when the child was hospitalized. The data were collected with a questionnaire between July and August, 1999, in a sample of 106 families who have hospitalized child. Family coping was assessed using Family Crisis Oriented Personal Evaluation Scale(F-COPES). Data was analyzed using correlation coefficent and analysis of variance. Positive correlation was found between social support, reframe with mobilizing the family to acquire and accept help in sub-domain of family coping. Strongest correlation existed between the family's spiritual support and total family coping. The type of diagnosis, the level of family income, religion, and child's age were significantly different in family coping. The result show that the family coping is affected by the characteristics of child and family, as well as the factors of coping activity. Therefore, early assessment of family coping skill and activity is important to the prevention of problem with function toward wholeness as a unit and child's well being. It can be used with a broad range of child's hospitalization process. It also serve as a nursing record and planning tool for documenting issues that may become priorities for future interventions.
Adaptation, Psychological ; Child ; Child, Hospitalized* ; Diagnosis ; Hospitalization ; Humans ; Nursing Care ; Nursing Records ; Child Health ; Surveys and Questionnaires

BACKGROUND: Acute idiopathic thrombocytopenic purpura(ITP) in children has a low morbidity and mortality, and most of cases are self limited illness. But some of them are not responsive to treatment and finally progress to chronic disease. The purpose of this study is to evaluate the factors which influence the outcome in childhood idiopathic thrombocytopenic purpura. METHOD: From January 1990 to December 1995, patients with ITP who were admitted to the Pediatric department of Pusan National University Hospital were divided into acute and chronic form depending on whether the platelet count had returned to normal(150 x 10(9)/1) by six months after diagnosis. Between two groups, the clinical and laboratory characteristics, response to treatment were compared. RESULT: 1) Out of 55 patients with ITP, 36 cases(65.5%) were acute and 19 cases(34.5%) were chronic ITP. 2) Sex, previous viral infection history, clinical manifestations were not significantly different between two groups, but the chronic ITP was rare in less than 1 year of age. 3) The duration of symptoms over >2 weeks at presentation was strongly predictive of chronic ITP. 4) Most of chronic disease (87.5%) showed platelet counts below 150 x 10(9)/1 at 28 days after diagnosis as compared with acute disease(25.0%). 5) Among 19 cases of chronic disease, 6 cases responded completely to treatment, but 11 cases(57.9%) did not respond to any treatments, 2 cases improved spontaneously. CONCLUSION: A history of symptoms over 2 weeks at presentation and platelet counts below 150 x 10(9)/1 at 28 days after diagnosis were strong predictors of chronic ITP in children.
Busan ; Child ; Chronic Disease ; Diagnosis ; Humans ; Mortality ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic*

Acute myocardial infarction after a bee sting is a very rare process. Among proposed mechanisms, vasospasm of the coronary artery is the most probable mechanism. Many mediators are included in the venom of wasps, and those mediators have vasoconstrictive properties and may constrict the coronary artery. Furthemore, those mediators have thrombogenic properties that lead to thrombogenesis in the coronary artery and aggravate myocardial ischemia. Epinephrine, commonly used in the management of anaphylactic shock, may further aggravate myocardial ischemia. We experienced two cases of acute myocardial infarction after a bee sting. In the first case, we could find no underlying abnormalities of the coronary vessel because the patient died during coronary angiography. In the second case, the electrocardiogram showed inferior wall myocardial infarction, but only mild stenosis of the right coronary artery was seen in coronary angiography.
Anaphylaxis ; Bees* ; Bites and Stings* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Electrocardiography ; Epinephrine ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Myocardial Ischemia ; Venoms ; Wasps

The results of ABO blood typing in 64-year-old patient with chronic renal and heart failure were positive with anti-B, delayed and weak positive with anti-A in the slide method for the cell typing, mixed-field agglutiniation by light microscopy in the tube method for the cell typing, and also was negative in anti-A, lectin and positive in anti-H, therefore blood typing of this patient was confirmed to A3B.
Blood Grouping and Crossmatching ; Heart Failure ; Humans ; Microscopy ; Middle Aged

Hemolytic disease of newborn due to Rhesus incompatibility occurs mostly by anti-Rh(D) antibodies. But recently, because of Rh(D) immune globuin prophylaxis, Rh(D) incompatibility is decreased and importance of minor group incompatibility is increasing. The majority of minor blood group incompatibilities are anti-c, anti-E or anti-Kell, but hemolytic diseases caused by combination of these antibodies are relatively rare. The 21 day-old male neonate was admitted because of pallor and poor feeding for 2 days. Laboratory data showed severe normochromic and normocytic anemia with increased reticulocyte and bilirubin. Patient's and his mothers blood type was B, Rh(D) positive. Minor blood groups of mother's and sons were different and anti-c and anti-E antibody were detected in mother's serum. After transfusions of two times with anti-c and anti-E free B, Rh(D) positive blood, the baby was discharged at 11th hospital day with good general condition.
Anemia ; Antibodies ; Bilirubin ; Blood Group Antigens ; Blood Group Incompatibility ; Erythroblastosis, Fetal ; Humans ; Infant, Newborn* ; Male ; Mothers ; Pallor ; Reticulocytes

PURPOSE: The purpose of study was to describe and evaluate the educational status regarding clinical practicum for child health nursing to facilitate student's clinical compliance for the bachelor's degree in Korea. Methods: The study was a descriptive study and included data from 40 institutions among the 53 university nursing programs in Korea(75.5% response rate). Data were collected using mailed semi structured questionnaires and content analysis was done. RESULTS: Findings show that most institutions have common learning objectives for the clinical practicum; neonatal care, high risk infant care, hospitalized child care, and advanced nursing practice. The mode for theoretical credits in child health nursing was 5 to 6 and 3 to 4 credits for clinical practice. The practice settings were prepared to provide diverse experiences, including childcare centers, and community centers with various learning activities. Evaluation for learning outcomes included faculty and instructors. It was pointed out that updating evaluation based on student and faculty feedback is important for a comprehensive practicum evaluation. Conclusions: Findings suggest that there is a -need for a generalized curriculum for clinical practicum and for the expanding role of advanced nursing practice-, a need for diverse clinical settings for practice, and effective guidance and learning activities. It is significantly noted that the attitude and teaching methodologies of clinical instructor's are highly important to effective clinical learning outcomes.
Child ; Child Health* ; Child* ; Child, Hospitalized ; Compliance ; Curriculum ; Educational Status ; Humans ; Infant ; Infant Care ; Korea* ; Learning ; Nursing* ; Postal Service ; Surveys and Questionnaires

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No abstract available.
Dacarbazine* ; Disseminated Intravascular Coagulation