Majolin's ulcer is a carcinomatous ulcer from degenerating burn scars. This patient is a 44 year-old man who has been suffering from pain and itching sensation on Rt. wrist of burn scars. Symptom has been developed since 18 months ago. Skin lesion is a well defined, slight brownish colored, scaly verrucous surfared plaque with reddish ringlike border and oozing tendency in small part. On physical examination, he is in within normal limit excepet burn scar on Rt. upper extremity. He was received burn with gasolin at the age of seven. Biopsy on the skin lesion revealed well differentiated squamous cell carcinoma appearance. Diagnosis was confirmed by the history and histopathological finding. Literature was briefly reviewed.
Adult ; Biopsy ; Burns ; Carcinoma, Squamous Cell ; Cicatrix ; Diagnosis ; Humans ; Physical Examination ; Pruritus ; Sensation ; Skin ; Ulcer* ; Upper Extremity ; Wrist

PURPOSE: The purpose of this study was to identify the process of overcoming the intention toward turnover experienced by career nurses. METHODS: Data were collected from 10 career nurses though in-depth interviews about their experiences. The main question was "How do you describe your experience of the process of overcoming intention to turnover as a career nurse?" Qualitative data from field and transcribed notes were analyzed using Strauss & Corbin's grounded theory methodology. RESULTS: From the participants' statement, 127 concepts, 34 subcategories and 13 categories were extracted through the open coding process. The core category was discovered to be 'back to the original place'. Phenomenon was identified as 'reached the threshold that cannot be withstood' and this series of process was categorized as having four stages: 'conflict', 'meditation', 'discovery' and 'conquest'. There were three types of overcoming turnover intention in career nurses, 'adjustment', 'compromise', 'self-led'. CONCLUSION: The results of this study produced useful information about the needs of career nurses during the process of overcoming turnover intention based on their stage and overcoming types of turnover intension. Ultimately this study may help decrease the turnover intention of career nurses.
Clinical Coding ; Intention

The non-surgical treatment for the fresh humeral shaft fracture would appeared to be not sufficient in respect of immobilization and maintenance of the contact surface of the fracture ends, which have had stimulated surgeons to perform internal fixation. This might be one of the reasons to produce non-union of humeral shaft fracture, supplemented by increasing incidence of fractures due to car and machinary accident. Authors have experienced 18 cases of non-union of humeral shaft fracture and accomplished solid union in all cases by osteosynthesis accompanied by autogenous bone graft. In detail: 1. Non-union was prevalent in the agr group of 20 to 40 and mostly in male. Site of non-union was found mostly at the lower 2/3. 2. The cause of the fracture was mainly due to the car and machinary accident. Initial treatments were surgical in 14 out of 18 cases, and 12 cases of this surgically treated group were treated within 2 days after the injury. 3. On retrospective analysis of medical records and X-ray films, probable cause of the non-union were supposed to be too early performed inadequate internal fixation and post-operative infection in the operated cases, whereas distraction of fracture ends due to poor external fixation and infection in the cases treated conservatively. 4. 16 cases of established non-union were treated by authors with rigid internal fixation and additional bone graft, and 1 case with bone graft only. 5. Authors have utilized shoulder spica or long arm cast post-operatively for 1 to 4 months. 6. Union was obtained in all cases. Developed transient radial nerve palsy in 4 cases; and neighbouring joints contracture in 2 cases, which required considerable time of physical therapy.
Arm ; Contracture ; Humans ; Immobilization ; Incidence ; Joints ; Male ; Medical Records ; Paralysis ; Radial Nerve ; Retrospective Studies ; Shoulder ; Surgeons ; Transplants ; X-Ray Film

No abstract available.
Child* ; Heart Diseases* ; Heart* ; Humans ; Mass Screening*

This study was done to evaluate the effect reducing artificial dead space on intubated children. Data were collected from July 1st, 1998 to August 31st, 1999. The subjects were selected from a pediatric intensive care unit of 'S' hospital and intubated with 3.5 mm or 4.5 mm endotracheal tube after open heart surgery. They were composed of 34 patients : 17 patients were assigned to the experimental group and the rest of them were placed in the control group. The artificial airway volume was minimized in the experimental group, and the control group maintained the artificial airway volume. ETCO2, PaCO2, SPO2 were measured as indicators of pulmonary ventilation. The tools of this study were GEM-Premier and Space-Lab patient monitors. The data were analyzed using the SPSS/PC+ program. The Chi2 -test was used to find general characteristics. The t-test was used to test the homogenety of the pulmonary ventilation status and mechanical ventilation setting before intervention between the two groups. Also, the paired t-test was used to examine the hypothesis. The results can be summerized as : 1. CO2 can be expelled effectively from the body in case artificial dead space was decreased. 2. As the artificial dead space was reduced, the difference between ETCO2 and PaCO2 was decreased, in other words pulmonary ventilation was improved. 3. If the artificial dead space occupied above 15 percent of tidal volume, the effect of CO2 was retention revealed in the body. 4. If the artificial dead space occupied below 1.5 percent of tidal volume, there was no dead space effect. Based on the results, the following is suggested to be applied practically : 1. A kind of the ventilator circuit acting artificial dead space should be removed from the intubated children with mechanical ventilaion. 2. The endotracheal tube should not be cut because extra-body space of the endotracheal tube did not have an effect on the dead space of the intubated children. Since the researcher could not cover this aspect in the study, they recommend the following. 1. The study should be extended to the other pulmonary disease patients for the effect of improving pulmonary ventilation. 2. Also, further studying with a more narrow interval in the extra-body space of the artificial airway will be able to explain the point of artificial dead space with proper ventilation.
Child* ; Humans ; Intensive Care Units ; Lung Diseases ; Pulmonary Ventilation* ; Respiration, Artificial* ; Thoracic Surgery ; Tidal Volume ; Ventilation ; Ventilators, Mechanical

PURPOSE: The purpose of this study is to analyze the change in re-osseointegration over time and bone reaction at the interface between implant fixture and the surface of the bone, after destroying re-osseointegration by distorting the bone-implant interface artificially. MATERIAL AND METHODS: Experimental implant fixtures (cp titanium, small ef, Cyrillic3.75 mm x 4 mm) which didn't have surface treatment were produced. Two or three fixtures were implanted on both tibias of twelve female rabbits (New Zealand white, more than 3.5 kg). Then after six weeks, removal torque (RT) was measured and the results were recorded as the first measurement values. The fixtures were submerged again to get reosseointegration between the bone and fixture. To identify the change in re-osseointegration of submerged fixtures over time, six groups had the healing time for four days (group I), one week (group II), two weeks (group III), three weeks (group IV), four weeks (group V) and five weeks (group VI), and then the secondary removal torque was measured for each group. To identify the bone formation under fluorescent light, tetracycline (15 mg/kg, IM) were treated on the rabbits of each group. After the second measurement, the rabbits were sacrificed, and 16 slides were made, two or three for each group. The slides were observed under the fluorescent light with light microscope. To find out the change in the secondary removal torque over the primary removal torque in progress of time, the averages of the increase rate of the primary and secondary torque removal force were calculated. Then, to find out if there were any critical differences between the primary removal torque and the secondary removal torque in each group and among the groups, the results were analyzed statistically by paired t-test, one-way ANOVA, and Duncan's Multiple Range Test. RESULTS: In group I and II, secondary removal torque decreased, especially in group I. In group III, IV, V, and VI, secondary removal torque increased critically. Comparing the differences among the groups, the critical difference was shown between group I, II and group III, IV, V, VI. Mineralization at the interface between the bone and implant fixture was identified from the first week, and bone formation was shown more clearly from the second week. CONCLUSION: If the implant fixture remains unforced for a certain period of time after the fixture has had iatrogenic mobility, re-osseointegration occurs at the surface of the fixture, and for tibias of rabbits, higher re-osseointegration was obtained within two weeks.
Female ; Humans ; Implants, Experimental ; Light ; Osseointegration ; Osteogenesis ; Rabbits ; Tetracycline ; Tibia ; Titanium ; Torque

BACKGROUND: Changes in acid-base balance and serum electrolytes by infusion of lactated Ringer's solution in liver cirrhosis patienst during liver surgery are poorly characterized. In this study, we evaluated the effects of infusing large amount of lactated Ringer's solution on acid-base and serum electrolytes during liver surgery in cirrhosis patients. METHODS: Thirty-two patients were divided into two groups. Group I (n = 21) was made up of patients who had received liver lobectomy without cirrhrosis. Group II (n = 11) was made up of patients who had received liver lobectomy with cirrhosis above a moderate level. Arterial blood gas and serum electrolyte levels were checked 4 times during the study in each patient: just after the operation start, after infusing 3,000 ml and 6,000 ml of lactated Ringer's solution during operation, and 30 minutes after arrival at the postanesthesia care unit. RESULTS: pH and base excess decreased according to the amount of lactated Ringer's solution used in both groups and these results were significant. Serum electrolyte levels were not changed and only Ca2+ levels were significantly different in the two groups. The cause of changing of Ca2+ levels found out by intravenous infusion of Ca2+ solution. CONCLUSIONS: In liver surgery patients with or without liver cirrhosis decreased pH and base excess in serum by increased amount of used lactated Ringers solution during liver surgery but in serum electrolytes and others acid-base parameters, CVP, changes on there were not any statistical significant. When a large amount of LR solution is used in liver surgery, we recommend regular arterial blood gas analyses for acid-base balance and an infusing speed of 20 ml/kg/h.
Acid-Base Equilibrium ; Blood Gas Analysis ; Electrolytes ; Fibrosis* ; Humans ; Hydrogen-Ion Concentration ; Infusions, Intravenous ; Liver Cirrhosis ; Liver*

Restrictive dermopathy is a rare autosomal recessive disorder in which rigidity or tautness of the skin from the second trimester causes a fetal akinesia deformation sequence (FADS) and early death. Characteristic features include taut skin with prominent subcutaneous vessels, widely open fontanelles and cranial sutures, distinctive facies, flexion contractures, pulmonary hypoplasia, sparse eyelashes and and eyebrows, thin dysplastic clavicles. The histologic abnormalities of the skin are located in a thin dermis, consisting of compactly arranged collagen fibers, scanty elastic fiber. The dermoepidermal junction is flat, and epidermal appendages are absent, miniaturized or immature. The presence of adipose tissue may be increased. We report on the first Korean case of restrictive dermopathy with typical clinical features and histological findings.
Adipose Tissue ; Clavicle ; Collagen ; Contracture ; Cranial Sutures ; Dermis ; Elastic Tissue ; Eyebrows ; Eyelashes ; Facies ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, Second ; Skin

PURPOSE: Warthin's tumor is a slow growing tumor found exclusively either in the parotid gland or the periparotid lymph nodes. Although surgical resection is the treatment of choice, the extent of surgery which is most beneficial has remained contraversial. We performed a comparative study of the results between enucleation and parotidectomy groups to evaluate the effectiveness of the enucleation procedure for the surgical management of parotid Warthins tumor. METHODS: Between January 1981 and July 2001, 74 patients underwent surgical resection of parotid Warthin's tumor. We reviewed the clinicopathological characteristics retrospectively and compared the operation time, postoperative complication rate, duration of postoperative hospital stay and recurrence between the enucleation group and the parotidectomy group. RESULTS: The mean age was 57.0 years (19~86 years) and the male to female ratio was 5.7: 1. The majority of the tumors were situated in the lower region of the superficial lobe (89.2%). Bilateral simultaneous involvements of the parotid gland was found in 5 patients (6.8%) and therefore a total of 79 parotid glands were involved. Four (5.4%) of the 79 parotid glands featured multifocal tumors of two or three lumps. Tumor sizes varied from 0.5 to 13.0 cm with a mean diameter of 3.5 cm. Of the 74 patients, 51 (68.9%) were diagnosed preoperatively or perioperatively by means of CT scans, ultrasound, 99m-Tc. scan, fine needle aspiration cytology or intraoperative frozen section biopsy. Of the 79 glands, 46 underwent a superficial (n=39), partial (n=2) or total (n=5) parotidectomy, while enucleation was performed for the remaining 33 cases with single Warthin's tumor. Only one case of recurrence was identified during the follow up period. However the operation time, the postoperative complication rate, and the duration of postoperative hospital stay were all significantly reduced in the enucleation group (P<0.05). CONCLUSION: The enucleation procedure may represent a safe and appropriate surgical method for patients with single Warthin's tumor that is diagnosed preoperatively.
Biopsy ; Biopsy, Fine-Needle ; Female ; Follow-Up Studies ; Frozen Sections ; Humans ; Length of Stay ; Lymph Nodes ; Male ; Parotid Gland ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography

From October 2005 to August 2006, sympathetic nerve reconstruction with using the intercostal nerve was performed in 4 patients with severe compensatory hyperhidrosis following thoracoscopic sympathetic surgery for facial hyperhidrosis. The interval between the initial sympathetic clipping and the sympathetic nerve reconstruction was a median of 23.1 months. The compensatory sweating after sympathetic nerve reconstruction was improved for 2 patients, but it was not improved for 2 patients. Thoracoscopic sympathetic nerve reconstruction may be one of the useful treatment methods for the patients with severe compensatory hyperhidrosis after they under go sympathetic nerve surgery for hyperhidrosis.
Humans ; Hyperhidrosis ; Intercostal Nerves ; Sweat ; Sweating ; Thoracoscopy ; Transplants