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Clinical Characteristics of Unstable Pelvic Bone Fractures Associated with Intra-abdominal Solid Organ Injury (불안정성 골반골 골절 손상에서 동반 복부 고형장기 손상의 임상적 특성)

  • Lee, Sang Won;Kim, Sun Hyu;Hong, Eun Seog;Ahn, Ryeok
    • Journal of Trauma and Injury
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    • v.25 no.1
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    • pp.1-6
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    • 2012
  • Purpose: This study analyzed the characteristics of unstable pelvic bone fractures associated with intra-abdominal solid organ injury. Methods: Medical records were retrospectively collected from January 2000 to December 2010 for patients with unstable pelvic bone fractures. Unstable pelvic bone fracture was defined as lateral compression types II and III, antero-posterior compression types II and III, vertical shear and combined type by young classification. Subjects were divided into two groups, with (injured group) and without (non-injured group) intra-abdominal solid organ injury, to evaluate whether the characteristics of the fractured depended on the presence of associated solid organ injury. Data included demographics, mechanism of injury, initial hemodynamic status, laboratory results, revised trauma score (RTS), abbreviated injury scale (AIS), injury severity score (ISS), amount of transfusion, admission to the intensive care unit (ICU), and mortality. Results: The subjects were 217 patients with a mean age of 44 years and included 134 male patients(61.8%). The injured group included 38 patients(16.9%). Traffic accidents were the most common mechanism of injury, and lateral compression was the most common type of fracture in all groups. The initial blood pressure was lower in the injured group, and the ISS was greater. The arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. The amount of the transfused packed red blood cells within 24 hours was higher in the injured group than the non-injured group. Invasive treatment, including surgery and angiographic embolization, was more common in the injured group, and the stay in the ICU was longer in the injured group. Conclusion: A need exists to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with unstable pelvic bone fractures and multiple associated injuries.

The Study of Alienation and Physical Aging in the Old People (노인의 소외감과 신체적 노화에 관한 연구)

  • 김미옥
    • Journal of Korean Academy of Nursing
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    • v.17 no.1
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    • pp.64-78
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    • 1987
  • This study is attempt to submit a basic material to help the efficient nursing management which supports and to understand the alienation which they percieve social-psychologically and physical aging bringing about the phf·sical powerlessness, to understand the old people in hospitals and in community and should build up their health. The data collection of the study which has been done on Sept. 7 to Sept. 20, 1986 is objected to 300 people of 65 years old of age or more of male and female who are staying at home. Analysis of the Data was done by use of percentage, t-test, ANOVA and Pearson Correlation Coefficients. The results of study are summerized as follows: 1. According to each age group of old people(p= .0008), family living together concreteness (p=.0000), the level of education (p=.0020), how much they are participating in leisure activity (p=.0001), whether they have mate or not (p=.0000), whether they have religion or not (p=.0000), the level of alienation showed difference statistically. Also, according to sex (p=.4315), whether they have income or not (p=.1197), the level of alienation did not show any difference statistically. 2. According to each age group of old people (p=.0000), family living together concreteness (p=.0060), the level of education (p=.0000), sex (p=.0000), whether they have mate or not (p=.0000), whether they have religion or not (p=.0067), whether they have income or not (p=.0000), the level of physical aging showed difference statistically. Also, according to how much they are participating in leisure activity, the level of physical aging did not show any difference statistically (p=4879). 3. The level of alienation and physical aging in old people had positive correlation (r=.5436, p<.001). From the above result, the level of social, psychological alienation and physical aging showed high for the old who had no mate, no religion, low in their educational level, living separately' with the family and for those who do not participate much in the leisure activities, The old people who feel the social, psychological alienation can expedite the physical aging and physical aging can be result from social psychological loneliness and alienation. Therefore, for the successful aging of the old people in the community with these weak points, we should provide them with physical and emotional, psycho-logical support and care in the basis of understanding in socialization process and the character of the physical functional change.

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A Case Report of Heart-Lung Transplantation (심장-폐 이식 증례 보고)

  • 노준량;허재학;오삼세;김영태;이정렬;이기봉;오병희;한성구
    • Journal of Chest Surgery
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    • v.31 no.10
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    • pp.1004-1008
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    • 1998
  • We report a case of heart-lung transplantation in a 32 year-old female with Eisenmenger syndrome secondary to patent ductus arteriosus. She has been suffered from congestive heart failure since June 1996 and repeatedly treated at Intensive Care Unit with intravenous inotropic support since July 1997. Preoperative echocardiography showed a patent ductus arteriosus with right to left shunt, severe regurgitation of tricuspid valve and estimated right ventricular systolic pressure of 100mmHg. The brain-dead donor was an 18 year-old male with head trauma from traffic accident 3 days ago. Heart-lung block procurement was performed at another general hospital and was transported to the Seoul National University Hospital by ambulance. Total ischemic time of the transplanted heart and lung were 249 minutes and 270 minutes, respectively. The immunosuppressive therapy was commenced preoperatively with cyclosporine and azathioprine. Corticosteroid was not used until postoperative 3 weeks in order to avoid infection and delayed healing at the tracheal anastomotic site. The patient was discharged at 31st postoperative day, and has been regularly followed up at outpatient clinic without specific complication. The follow-up bronchoscopy, performed 2 weeks and 4 months after surgery, revealed no evidence of cellular rejection.

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Influencing and Mediating Factors in Stroke: Based on 2007-2012 Korea National Health and Nutrition Examination Survey (뇌졸중의 영향 요인과 매개요인)

  • Bae, Seung-Geun;Lee, Sung-Kook;Han, Chang-Hyun
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.16 no.1
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    • pp.418-428
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    • 2015
  • This study conducted influencing and mediated effect on stroke to lead correct health behavior of stroke patients and tried to provide preliminary data of stroke prevention. It used stage 4 and 5 data of a national health and nutrition examination survey, analysis method was frequency analysis, Chi-square test, multiple logistic regression and structural equation modeling. In case of male, factors affecting to stroke were age, job, self-related health, alcohol, hypertention and diabetes. In case of female, age, job, self-related health, stress level and hypertention affected to stroke. In tested results on whether or not mediated effect of preceding disease exists, 5.80 difference in ${\chi}^2$ between partial mediated modeling and full mediated modeling was statistically significant(p<0.01). Therefore, partial mediated modeling was adequate to this study. We need preventive health education for changing wrong health behaviors and policy that strengthens health care network. If someone has preceding disease, they need long-term diagnosis for health condition and continuous improvement in life style.

An Observation of the Chief Complaints of Pediatric Outpatients (소아과(小兒科) 외래(外來) 환자(患者)의 주소증(主訴症)에 관(關)한 연구(硏究)(동국분당한방병원 : 1997년 1월 1일 ${\sim}$ 1997년 12월 31일))

  • Oh Ha-Seok;Kim Jang-Hyun
    • The Journal of Pediatrics of Korean Medicine
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    • v.12 no.1
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    • pp.63-76
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    • 1998
  • BACKGROUND : The purpose of this study was to investigate the new effective oriental medical treatments in pediatric diseases and its clinical applicability. METHOD : The study was composed of 1725 new patients who had been treated at the pediatric unit in the Dongguk Bun-Dang Oriental Medicine Hospital for 1 year, from 1 January 1997 to 31 December 1997, and had ages between 0 and 18 years. The chief complaint was mainly categorized by oral examination on patients and their care-givers. RESULT 1. The ratio of male to female was 1.35:1 and the number of each age group and its percentage distribution was 228 patients (13.2%) for the age group between 0 and 1 year, 746 patients (43.2%) between 2 and 6 years, and 751 patients (43.6%) for the age group over 7 years. 2. The chief complaint of the new outpatients was weakness, asthma, common cold, sinustis, skeletal disease, atopic dermatitis, stomach-ache, short stature, diarrhea, nasal blooding, night terror, allergic rhinitis, gastric disorder, enuresis, dermatitis, strabismus in the order of majority.3. The number of patients and its percentage for the most three complaints was 494 patients (28.6%) for weakness, 647 patients (37.4%) for respiratory disease, 144 patients (8.3%) for digestive disease. 4. The digestive disease tended to increase in summer, and appeared mostly in the age group between 0 and 2 years. The respiratory disease increased In inter-season and winter, but decreased significantly in summer. The age group between 1 and 5 years was the largest group of respiratory disease. CONCLUSION 1. The chief complaint in pediatric diseases that needed an oriental medical treatment was mainly the disease that tends to take long time and the weakness, and appeared frequently in digestive and respiratory diseases. 2. The oriental medical treatment was still preferred as a way to improve the weakness by patients, rather than a way to overcome their disease. In particular, the study shows that the oriental medical treatment should be emphasized in terms of preventing the disease. 3. The new diseases, which were developed with the change of human life and environment, (atopic dermatitis, enuresis, short stature, obesity, dysthymic disorder, strabismus), should be investigated as a new field of oriental medical treatment.

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Reccurent Foreign body Granuloma after Gore-tex Removal in Rhinoplasty (융비술에서 고어텍스 제거 후 발생한 재발성 이물성 육아종의 치험례)

  • Kwon, Soon Geun;You, Young Cheun;Yang, Won Yong;Park, Jun;Kang, Sang Yun
    • Archives of Plastic Surgery
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    • v.35 no.5
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    • pp.611-614
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    • 2008
  • Purpose: Infection, foreign body reaction and decreased volume of implant are common complications after augmentation rhinoplasty with $Gore-tex^{(R)}$ implant. The author experienced two cases of recurrent foreign body granuloma in the patients who underwent $Gore-tex^{(R)}$ removal because of infection after augmentation rhinoplasty. and treated them with complete removal of$Gore-tex^{(R)}$. Methods: Case 1: A 49 year-old female visited our clinic for recurrent foreign body reaction on nasal dorsum and tip area. The patient underwent augmentation rhinoplasty with $Gore-tex^{(R)}$ 3 years ago and implant was removed due to infection 9 months ago. Excision of the granuloma was performed and a piece of foreign body suspicious to be a $Gore-tex^{(R)}$ implant debris was detected under the subcutaneous pocket. The implant fragments were removed and nasalis muscle rotation flap was performed to cover the lesion. The specimen was proved to be $Gore-tex^{(R)}$ in histological study. Case 2: A 31 year-old-male with recurrent foreign body granuloma on the nasal tip area visited our clinic. 10 years ago, the patient had augmentation rhinoplasty with silicone implant and then, he underwent revisional rhinoplasty five times including nasal implant removal, which was performed 9 months ago. The authors excised the granuloma and found a small sized foreign body suspicious to be a $Gore-tex^{(R)}$ implant debris under the granuloma. The foreign body was excised and identified to be $Gore-tex^{(R)}$ in histological study. Results: In both cases, the lesions were healed without any complications and there were no evidences of recurrence up to 6 months of follow-up. Conclusion: The $Gore-tex^{(R)}$ is known to be weak against mechanical force. These properties of $Gore-tex^{(R)}$ make it difficult to remove the implant completely. In the patient who have infection after augmentation rhinoplasty with $Gore-tex^{(R)}$, the operator should take care to perform the complete removal without remaining fragment of the implant.

Congenital Syphilis: An Uncommon Cause of Gross Hematuria, Skin Rash, and Pneumonia (신생아에서 혈뇨와 폐렴이 동반된 선천 매독 1례)

  • Shim, Sun Hee;Kim, Ju Young;Lee, Eu Kyoung;Bang, Kyongwon;Cho, Kyoung Soon;Lee, Juyoung;Suh, Jin-Soon;Bin, Joong Hyun;Kim, Hyun Hee;Lee, Won Bae
    • Pediatric Infection and Vaccine
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    • v.21 no.1
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    • pp.65-70
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    • 2014
  • Although congenital syphilis can be prevented with prenatal screening, the disease remains problematic. Currently, there are no cases that describe hematuria and pneumonia related to congenital syphilis. We report a case of congenital syphilis that involved nephrotic syndrome and pneumonia alba in a 22-day-old male infant whose mother did not receive adequate prenatal care. The congenital syphilis diagnosis was confirmed with a serologic test and the patient recovered with penicillin treatment. Clinical findings may be subtle in neonates and delayed recognition occurs frequently, thus complete prenatal screening is critical for congenital syphilis prevention. Immediate serologic testing should be performed to obtain a differential diagnosis if an infant is delivered by a mother that has not received appropriate prenatal examinations.

Early Surgical Stabilization of Ribs for Severe Multiple Rib Fractures (중증 다발성 늑골골절에 대한 조기 수술적 늑골고정술)

  • Hwang, Jung-Joo;Kim, Young-Jin;Ryu, Han-Young;Cho, Hyun-Min
    • Journal of Trauma and Injury
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    • v.24 no.1
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    • pp.12-17
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    • 2011
  • Purpose: A rib fracture secondary to blunt thoracic trauma continues to be an important injury with significant complications. Unfortunately, there are no definite treatment guidelines for severe multiple rib fractures. The purpose of this study was to evaluate the result of early operative stabilization and to find the risk factors of surgical fixation in patients with bilateral multiple rib fractures or flail segments. Methods: From December 2005 to December 2008, the medical records of all patients who underwent operative stabilization of ribs for severe multiple rib fractures were reviewed. We investigated patients' demographics, preoperative comorbidities, underlying lung disease, chest trauma, other associated injuries, number of surgical rib fixation, combined operations, perioperative ventilator support, and postoperative complications to find the factors affecting the mortality after surgical treatment. Results: The mean age of the 96 patients who underwent surgical stabilization for bilateral multiple rib fractures or flail segments was 56.7 years (range: 22 to 82 years), and the male-to-female ratio was 3.6:1. Among the 96 patients, 16 patients (16.7%) underwent reoperation under general or epidural anesthesia due to remaining fracture with severe displacement. The surgical mortality of severe multiple rib fractures was 8.3% (8/96), 7 of those 8 patients (87.5%) dying from acute respiratory distress syndrome or sepsis. And the other one patient expired from acute myocardial infarction. The risk factors affecting mortality were liver cirrhosis, chronic obstructive pulmonary disease, concomitant severe head or abdominal injuries, perioperative ventilator care, postoperative bleeding or pneumonia, and tracheostomy. However, age, number of fractured ribs, lung parenchymal injury, pulmonary contusion and combined operations were not significantly related to mortality. Conclusion: In the present study, surgical fixation of ribs could be carried out as a first-line therapeutic option for bilateral rib fractures or flail segments without significant complications if the risk factors associated with mortality were carefully considered. Furthermore, with a view of restoring pulmonary function, as well as chest wall configuration, early operative stabilization of the ribs is more helpful than conventional treatment for patients with severe multiple rib fractures.

Change of Psychological Well-being by Participating in an after School Physical Training Activity (방과후체육활동 참여에 따른 심리적 안녕감 변화)

  • Lim, Tae-Hee;Kim, Dong-Hyun
    • The Journal of the Korea Contents Association
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    • v.14 no.8
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    • pp.453-465
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    • 2014
  • The purpose of this study was to find out the change in psychological well-being of middle school students by participating in after school physical training activities. To achieve this object, 100 male students of M middle school in K city. "Teenagers' psychological well-being measurement tool" developed by Chung-hee Park(2007). Twice a week, for twelve weeks, the experimental group took part in an after school physical training activity, and the control group, in non-physical classes. The conclusion reached based on the result of this study are as follows. First, there was a statistically significant difference in the change of the family relations factor. Second, there was no statistically significant difference in the change of the student-teacher relations factor between the group Third, there was a statistically significant difference in the change of the self-awareness factor between the group. Fourth, there was no statistically significant difference in the change of the self assertiveness factor between the group. Fifth, there was a statistically significant difference in the change of the friendship factor between the group. Sixth, there was no statistically significant difference in the change of the self-initiative studying factor between the group. In conclusion, taking part in an after school physical training activity on a regular basis can increase the feeling of care and love from family relations, give positive self awareness and attitude towards life, and help building mutual trust between friends by having close relationship.

Development of Sexual Autonomy Measurement for College Students (대학생의 성적 자율성 측정도구 개발)

  • Chang, Soon-Bok
    • Women's Health Nursing
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    • v.8 no.1
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    • pp.106-115
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    • 2002
  • Little is known about sexual autonomy in the light of human sexual health or sexual behavior. The purpose of this study was to increase understanding of sexual autonomy by developing a scale to measure sexual autonomy in college students. The measure was based on the perspective of human beings as having autonomy. A methodological developmental design was used. The study was done in three steps and included concept development through content analysis of relevant literature individual interviews using open-ended questions with 19 college students, item analysis of data from self report questionnaires for item to total correlation, content validity index by professionals and college students, and factor analysis with principal component analysis. Three groups participated in testing the measurement scale; Group A in 1998, a nationwide convenience sample of college students (n=1,163), Group B, college students in 1999 (n=233), and Group C, college students in 2000 who responded to the measurement scale before and after a sex education program (n=216). A series of exploratory and confirmatory factor analyses were conducted to test validity. For analysis of the questionnaires, statistical methods including reliability (test-retest), item to total analysis, content validity, factor analysis for construct validity and t-test for mean difference according to gender, sexual coitus, previous sex education, and pre-post experiment sex education were used with SPSS 10.0. Results: 1. Two stable factors were extracted and these contributed 48.05% of the variance in the total score. All 13 items loaded above .40 on each factor. 2. Factor I with 10 items was named 'control' and factor II with 3 items and was named 'coping'. 3. Differences in sexual autonomy scores for college students according to their experience showed that there were significantly higher scores for sexual autonomy in the post sex education group(t=-10.841, p=.000), but there were no differences according to whether or not they had previous sex education. Female college students had higher sexual autonomy scores than male college students in A or B group (t=-5.933, p=.000/ t=-1.992, p=.048). 4. Cronbach's $\alpha$ was .8603 for the total 13 items with 1,632 college students, .8739 with 232 students, .8333$\sim$.7647 with pre-post sex education with 216 students. This measurement was found to have a high validity and reliability for measuring sexual autonomy in college students. Therefore, the author recommends that it be used to measure the effects of sex education. It is suggested that further study is needed to analyze the relationship between sexual autonomy and sexual behavior.

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