PURPOSE: To evaluate the incidence of disc extrusion and neurologic deficit, the relation between disc extrusion and neurologic deficit and the treatment results according to our basic treatment principles in lower cervical facet joint fracture and dislocations MATERIALS AND METHODS: Twelve patients were evaluated, 8 male and 4 female with an average age of 41 years comprised the group. Six injuries were attributable to automobile accidents, 5 to fall from building, bed, floor and hill, and one to stand on her head. One case was distractive-flexion stage (DFS) 1, 9 cases with DFS 2 and 2 cases with DFS 3. Plain X-ray, CT, Myelo CT and MRI were used as a diagnostic tools. As a treatment criteria, feasibility of closed reduction, status of neuroglogic injury, and stability of injured spine were considered. Anterior cervical discectomy and fusion in accompanied disc extrusion, posterior reduction and fusion with triple wiring in unreduced dislocation, and anterior decompression and fusion in incomplete cord and root injury were selected as a basic treatment principles. RESULTS: Ten out of 12 cases (83%) showed neurologic deficits, 2 complete cord injury, 1 incomplete cord injury, and 7 radiculopathy. Nine out of 12 (75%) demonstrated disc extrusion and all disc extruded patients had neurologic deficits. Anterior cervical discectomy and fusion (ACDF) were performed in 5 cases, ACDF and posterior reduction with triple wiring (PRTW) in 4 cases, PRTW in 1 case, and skull traction and philadelphia brace in 2 cases. Seven radiculpathy patients were completely recovered and one incomplete cord injury patient can ambulate with spastic gait after surgery. There were 2 bed sore and 1 pneumonia in complications. CONCLUSION: Soft disc extrusion should be evaluated carefully with MRI and CT in lower cervical spine injury with the facet joint fracture-dislocations before the decision of treatment. As disc extrusion always accompanies neurologic deficit, it must be surgically treated by anterior cervical discectomy and fusion.
Automobiles ; Braces ; Decompression ; Diskectomy ; Dislocations* ; Female ; Gait Disorders, Neurologic ; Head ; Humans ; Incidence ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Pneumonia ; Pressure Ulcer ; Radiculopathy ; Skull ; Spine ; Traction ; Zygapophyseal Joint*

A endodermal sinus tumer (Teilum) is a highly malignant germ cell tumor showing a selective overgrowth of yalk sac endoderm intimately associated with the extraembryonic mesoblast. Several cases of the tumor originating from the ovaries have been reported in the literature. We present a case of the tumor with a rare origin from the sacrococcygeal region.
Endoderm ; Endodermal Sinus Tumor ; Female ; Neoplasms, Germ Cell and Embryonal ; Ovary ; Sacrococcygeal Region

We would like to correct the affiliation for the first author.

We analysed 8 cases of gastrointestinal cytomegalovirus(CMV) infection including one autopsy, three surgically resected and four endoscopic biopsy cases. Involved sites were colon in four,stomach in three and small intestine in one. Three of them were associated with immu-nosuppressed condition but others had no clinical evidence of immune deficiency. Multiple aphthous mucosal ulceration was a common presentation, but one revealed a mucosal ulcer with segmental narrowing and thickening of wall. Microscopically, six showed cytomegalic inclusions in endothelial cells and fibroblasts, one in mucosal epithelial cells and the remaining one in both endothelial cells and mucosal epithelial cells. Immunohistochemical staining using monoclonal antibody against CMV confirmed postive result in seven cases. Serum IgM anti-CMV antibody was elevated in one case. We conclude that gastrointestinal CMV infection is currently not a rare condition and frequently associated with non-immunosuppressed condition, and thus a thorough histologic examination is required especially in the gastrointestinal ulcerative lesion. Once cytomegalic inclusion is suspected, immunohistochemical identification of CMV seems essential for specific diagnosis.
Biopsy

PURPOSE: In this study a system dynamics methodology was used to identify correlation and nonlinear feedback structure among factors affecting unplanned extubation (UE) of ICU patients and to construct and verify a simulation model. METHODS: Factors affecting UE were identified through a theoretical background established by reviewing literature and preceding studies and referencing various statistical data. Related variables were decided through verification of content validity by an expert group. A causal loop diagram (CLD) was made based on the variables. Stock & Flow modeling using Vensim PLE Plus Version 6.0b was performed to establish a model for UE. RESULTS: Based on the literature review and expert verification, 18 variables associated with UE were identified and CLD was prepared. From the prepared CLD, a model was developed by converting to the Stock & Flow Diagram. Results of the simulation showed that patient stress, patient in an agitated state, restraint application, patient movability, and individual intensive nursing were variables giving the greatest effect to UE probability. To verify agreement of the UE model with real situations, simulation with 5 cases was performed. Equation check and sensitivity analysis on TIME STEP were executed to validate model integrity. CONCLUSION: Results show that identification of a proper model enables prediction of UE probability. This prediction allows for adjustment of related factors, and provides basic data do develop nursing interventions to decrease UE.
Adult ; Airway Extubation/*psychology ; Female ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Male ; Middle Aged ; *Models, Theoretical ; Nonlinear Dynamics ; Risk Factors

PURPOSE: This study was done to examine the effects of oral care with essential oil in improving the oral health status of hospice patients with terminal cancer. METHODS: The participants were 43 patients with terminal cancer admitted to K hospital in G city, Korea. Twenty-two patients were assigned to the experimental group and 21 to the control group. Participants in the experimental group received special mouth care with essential oil (application of essential oil mixture consisting of geranium, lavender, tea tree, and peppermint). The control group received special mouth care with 0.9% saline. The special mouth care was performed twice daily for one week in both groups. The scores for subjective oral comfortness, objective oral state, and numbers of colonizing Candida albicans were measured before and after the treatment. RESULTS: The score for subjective oral comfortness and objective oral state were significantly higher in the experimental group compared to the control group. The numbers of colonizing Candida albicans significantly decreased in the experimental group compared to the control group. CONCLUSION: Oral care with essential oil could be an effective oral health nursing intervention for hospice patients with terminal cancer.
Aged ; Aged, 80 and over ; Candida albicans/drug effects ; *Hospice Care ; Hospices ; Humans ; Middle Aged ; Neoplasms/therapy ; Oils, Volatile/*administration & dosage ; *Oral Health ; Questionnaires

Nutrition care is important for patients’ well-being. With legislation for reimbursement for nutrition support team activities from the Korea Ministry of Health and Welfare, this has increased the importance of nurses’ role in nutrition. Nutrition support nurses (NSNs) focus on the optimization of nutritional health and prevention of nutrition-related illness and injury. NSN performs as an advanced practice nurse, a core member of a nutrition support team, an educator or consultant, a policy maker in nutrition care, and a researcher or a member of quality improvement. NSNs should develop their core competency to fulfill their roles in nutrition care and the need to participate in qualified nutrition support education programs. Further, the tasks and duties of NSNs should be specifically identified so that NSNs can fulfill their roles.

We performed a retrospective analysis of the results of surgical treatment of sixteen patient with comminuted fracture of the distal femur from September 1993 to August 1995 and evaluated the efficacy of the angled blade plate as one of the fixation devices used. The fractures were limited to C2 and C3 fracture classifed according to the AO classification. After an average follow-up of 13 months (range, 9 to 24 months), all of the fractures had healed. Postoperatively, the arc of flexion was limited between 90degrees and 125degrees in eight, normal arc in five, and severely restricted arc of joint motion was present unexceptionally in three patients with deep infection. In angular deformity, average 5.8degrees of valgus and 2.4degrees posterior angulation were showed. The functional results by Sanders-Swiontkowski-Rosen-Helfet rating system were showed excellent in 3, good in 7, fair in 3, and poor in 3 cases. The overall results were seen to be excellent to good in ten cases (62.5%) but in twelve patients using the angled blade plate, excellent to good results were showed 10 patients (83.3%). We attribute the favorable results in our series to restoration of the articular surface through the modified extensile approach, sufficient stable fixation using the angled blade plate with conforming to the concept of bridge plate, routinely performing the bone graft for medial buttress and bone healing, and early mobilization of the extremity.
Classification ; Congenital Abnormalities ; Early Ambulation ; Extremities ; Femur* ; Follow-Up Studies ; Fractures, Comminuted ; Humans ; Joints ; Retrospective Studies ; Transplants

We noticed a group of thoracolumbar and lumbar spine fractures showing a unique fracture pattern that consisted of 1) superior disc injury, 2) crush fracture of the upper half of the vertebral body, 3) sagittal fracture of the lower half of the vertebral body, 4) bone fragments in the spinal canal, and 5) lamina fracture. Some of these fracture patterns were present in type B burst fracture of Denis classification. The purpose of this study was to compare the difference between crush-cleavage fracture and type B burst fracture in the viewpoint of neural canal involvement and neurologic status, and functional outcome with surgical treatment. Ten cases were identified as crush-cleavage fractures in 22 type B burst fractures during a 5 year period from Mar. 1989 to Jun. 1993 at the Department of Orthopedic Surgery of Chonbuk National University Hospital. Four out of 10 crush-cleavage fractures and 4 out of 12 type B burst fractures were paraparetic. Crush-cleavage fracture must be an unstable thoracolumbar comminuted fracture, but there were no significant differences in the neural canal involvement, incidence of neurologic deficit, and in the functional outcome, compared with type B burst fracture (P>0.05). It could be classified as a progressed form of type B burst fracture in Denis classification, or as a burst-split fracture in Magerl classification in the anatomical viewpoint. In conclusion, crush-cleavage fracture must be a variant of burst fracture.
Classification ; Fractures, Comminuted ; Incidence ; Jeollabuk-do ; Neural Tube ; Neurologic Manifestations ; Orthopedics ; Spinal Canal ; Spine

It has been shown that wornen with endometriosis have several immunological defects. The effect of interleukin-2 (IL-2) for the treatment of induced endometriosis in rat was studied. The results obtained are as followings: proliferation of epithelium is increased, and the inner surface is undulated with 1.5 nM IL-2. In 7.5 nM IL-2, the epithelial cells are changed to columar ones, and secretory hobs are observed at the apex of individual cell. Secretory activity of epithelium is increased with 0.5 nM IL-2, and apoptosis of the epithelial cell is observed in 15 nM IL-2. The levels of progesterone and estradiol in sera of rat were increased after treatment with IL-2 and were highest in the concentration of 1.5 nM IL-2. The results of this study can be a guide in the development of new therapeutic approaches for the treatment of endometriosis.
Animals ; Apoptosis ; Endometriosis ; Epithelial Cells ; Epithelium ; Estradiol ; Female ; Interleukin-2* ; Progesterone ; Rats*