Risk Factors of Work-related Upper Extremity Musculoskeletal Disorders in Male Shipyard Workers: Structural Equation Model Analysis

OBJECTIVES: This study was conducted to develop a model describing the interaction between lifestyle, job, and postural factors and parts of the upper extremities in shipyard workers. METHODS: A questionnaire survey was given to 2,140 workers at a shipyard in Ulsan City. The questionnaire consisted of questions regarding the subjects' general characteristics, lifestyle, tenure, physical burden, job control, posture and musculoskeletal symptoms. The overall relationship between variables was analyzed by a structural equation model (SEM). RESULTS: The positive rate of upper extremity musculoskeletal symptoms increased in employees who worked longer hours, had severe physical burden, and did not have any control over their job. Work with a more frequent unstable posture and for longer hours was also associated with an increased positive rate of musculoskeletal symptoms. Multiple logistic regression analysis showed that unstable posture and physical burden were closely related to the positive rate of musculoskeletal symptoms after controlling for age, smoking, drinking, exercise, tenure, and job control. In SEM analysis, work-related musculoskeletal disease was influenced directly and indirectly by physical and job stress factors, lifestyle, age, and tenure (p < 0.05). The strongest correlations were found between physical factors and work-related musculoskeletal disease. CONCLUSION: The model in this study provides a better approximation of the complexity of the actual relationship between risk factors and work-related musculoskeletal disorders. Among the variables evaluated in this study, physical factors (work posture) had the strongest association with musculoskeletal disorders.

Treatment of Posttraumatic Facial Deformity Patient with Brown's Syndrome: Case Report

PURPOSE: Brown's syndrome is characterized by the limited elevation in adduction from mechanical causes around the superior oblique tendon trochlea complex. In this particular case, post-traumatic facial deformity accompanied by Brown's syndrome was observed. We would like to report the satisfying cosmetic results obtained by reconstructing orbital roof and superior orbital rim and repositioning of zygoma. METHODS: A 12-year-old patient was observed with facial deformity with strabismus in her right eye and orbital dystopia after the car accident and was eventually diagnosed with traumatic Brown's syndrome. Reconstructive surgeries could not be performed at the time of trauma due to the cerebral hemorrhage. At the second year after the trauma, a depressed fracture of the right orbital roof and superior orbital rim were reconstructed via the intracranial approach, and orbital dystopia was corrected via the zygoma triple ostectomy. In addition, a strabismus surgery was performed one year after her plastic surgery. RESULTS: Facial deformity with orbital dystopia and strabismus was confirmed to be fully reconstructed after the surgery. Moreover, when the patient came in for a follow-up thirteen years after the operation, a developmental imbalance of the facial bones, diplopia, or any other surgical complications were not to be found. CONCLUSION: After the trauma, the patient with Brown's Syndrome accompanied by post-traumatic facial deformity, who went under the corrective surgeries after the meticulous examination and assessment pre-surgically, was able to acquire cosmetic satisfaction via those operations.

Malignant Hidroacanthoma Simplex: A Case Report

PURPOSE: Hidroacanthoma simplex (HAS) is a rare benign neoplasm of the skin and known as intraepidermal poroma. Malignant transformation of HAS has been reported in the literature, but it is very rare. We experienced a case of malignant hidroacanthoma simplex (MHA) and performed the surgery of the neoplasm. METHODS: A 73-year-old patient visited our department for evaluation and treatment of the skin lesion (3.2 x 3.0 cm2) that occurred two years before on the right ankle area. The lesion was characterized by dark-brown, hyperkeratotic and protruding patch. The patient had no symptom, and any palpable lymph node was not found on physical examination. The result of laboratory was also nonspecific. The lesion was excised completely with a resection margin of 5 mm including subcutaneous tissue partially, followed by full-thickness skin graft for reconstruction. RESULTS: The result of biopsy was reported as malignant hidroacanthoma simplex. Histologically, the epidermis showed discrete aggregates of tumor cells which had round, hyperchromatic nuclei and pale or clear abundant cytoplasm. Cystic spaces were found within the tumor and mitosis were seen, frequently. No recurrence was found one month after surgery. CONCLUSION: The case of malignant hidroacanthoma simplex was treated with full-thickness skin graft following wide excision of the tumor.

Malignant Hidroacanthoma Simplex: A Case Report

PURPOSE: Hidroacanthoma simplex (HAS) is a rare benign neoplasm of the skin and known as intraepidermal poroma. Malignant transformation of HAS has been reported in the literature, but it is very rare. We experienced a case of malignant hidroacanthoma simplex (MHA) and performed the surgery of the neoplasm. METHODS: A 73-year-old patient visited our department for evaluation and treatment of the skin lesion (3.2 x 3.0 cm2) that occurred two years before on the right ankle area. The lesion was characterized by dark-brown, hyperkeratotic and protruding patch. The patient had no symptom, and any palpable lymph node was not found on physical examination. The result of laboratory was also nonspecific. The lesion was excised completely with a resection margin of 5 mm including subcutaneous tissue partially, followed by full-thickness skin graft for reconstruction. RESULTS: The result of biopsy was reported as malignant hidroacanthoma simplex. Histologically, the epidermis showed discrete aggregates of tumor cells which had round, hyperchromatic nuclei and pale or clear abundant cytoplasm. Cystic spaces were found within the tumor and mitosis were seen, frequently. No recurrence was found one month after surgery. CONCLUSION: The case of malignant hidroacanthoma simplex was treated with full-thickness skin graft following wide excision of the tumor.

The Growth of Osteoblasts according to the Pretreatment of HA Scaffold Surface

PURPOSE: Recently, bioceramics have become popular as a substitute graft material for reconstruction of bony defect after trauma or tumor surgery. Among the bioceramic materials, hydroxyapatite(HA) is favored due to its biocompatibility. HA scaffold is composed of the interconnected reticular framework, macropores and micropores. Macropores play an important role in cell migration, nutrients supply and vascular ingrowth. On the other hand, a number of micropores less than 10micrometer form an irregular surface on HA scaffolds, which prevents the osteoblast from adhering and proliferating on the surface of HA scaffold. METHODS: In this study, three different groups were designed for comparison. In the first group(group A), conventional method was used, in which HA pellet was applied without surface pretreatment. The second group (group B) was given a HA pellet that has been coated with crystalline HA solution prior to application. In the third group(group C), the same method was used as the second group, where the pretreated HA pellet was heated(1250degrees C, 1 hour) before application. Osteoblast-like cells(2x10(4)/mL) were scattered onto every pellet, then they were incubated in 5% CO2 incubator at 37degrees C for twelve days. During the first three days, osteoblast cells were counted using the hemocytometer daily. ALP activity was measured on the 3, 6, 9 and 12 culture days using the spectrophotometer. RESULTS: Under SEM, group A showed a surface with numerous micropores, and group B revealed more rough crystal surface. Group C revealed a fused crystal appearance and flattened smooth surface. In proliferation and ALP activity of osteoblast cells, group C showed better results compared to group B. Group A which lacks pretreatment of the surface showed less osteoblast proliferation and ALP activity than group C, but showed better results than group B. CONCLUSION: We found that crystallized HA with heat treatment method enhances the osteoblasts proliferation and differentiation on the surface of HA pellets.

The Accelerated Epithelization of Recombinant Epidermal Growth Factor on Partial-thickness Skin Wounds

PURPOSE: Recent studies have already demonstrated experimentally that the topical application of epidermal growth factor (EGF) accelerates the healing of partial-thickness wounds. Although previous studies have proved the effect of recombinant human EGF (rhEGF), the clinical use of rhEGF in case of patients have generated some controversy in advantage. In this study, twelve patients had partial thickness wounds because of burn and skin graft donor site were treated with rhEGF and we investigated the clinical effect of rhEGF on partial thickness wounds of patients. METHODS: We evaluated two groups of patients had partial-thickness wounds. One group (n=5) is consisted of the patients have second degree burn wounds, and the other group (n=7) is consisted of the patients have donor site wounds after skin graft. Each wound was divided two area, one area was applied twice daily with rhEGF and the other area was treated without rhEGF. The extent of reepithelized area was recorded by percentage ratio. And the statistical analysis was conducted about the difference of the number of days between two area until total wound was reepithelized. RESULTS: In the group treated with rhEGF, the mean of time to healing was about 9.75 days, whereas, in the group without rhEGF, it was about 11.08 days. In the number of days until total wound was reepithelized, there were statistically significant difference between two groups (P<0.05). CONCLUSION: It was concluded that the topical application of rhEGF accelerated the healing of partial-thickness wound clinically.

The Treatment for The Intractable Epidural Abscess Using Tensor Fascia Lata Graft and Anterolateral Thigh Free Flap

PURPOSE: Artificial dura maters are commonly used in cranioplasty, but sometimes they can result in serious postoperative infection. Once complications such as epidural abscess or chronic draining ulcer arise, they are very difficult to treat. In this case, reclosure of dura defect using artificial dura mater may give rise to recurrence of infection. We experienced a case of intractable epidural abscess caused by use of artificial dura. To avoid repeated infection, we decided to use autologous tissue for the coverage of dura and soft tissue defect. Therefore, autologous tensor fascia lata graft and anterolateral thigh free flap were harvested at the same donor site incision to cover composite defect on the scalp and dura mater. METHODS: A 13 year old male patient, who underwent the decompression cranioplasty and duroplasty, suffered from the intractable infection lesion. Twice, the epidural abscess was removed, both times the infection recurred. And eventually dura mater was exposed through the infected open wound. Nine months after dura exposed, infected aritificial dura mater was removed and extensive debridement was performed. Through a surgical incision on donor thigh, first, tensor fascia lata graft was harvested in process of the anterolateral thigh flap elevation. After the fascia lata graft was fixed over the dural defect, the anterolateral thigh flap was used to fill the dead space as well as the scalp defect. RESULTS: Postoperatively, no recurrent infection and cerebrospinal fluid leakage are observed for a year. After the surgery, on the first and second day, venous congestion of the flap was observed, this problem was solved by thrombectomy and vein reanastomosis. And partial necrosis of flap occurred, but completely healed as conservative treatment for two weeks. CONCLUSION: Using the autologous tensor fascia lata graft and anterolateral thigh flap, we could obtain satisfactory results as treatment for the intractable infection lesion after duroplasty. Autologous tensor fascia lata in conjunction with anterolateral thigh flap is useful method for covering composite defect of scalp and dura mater.

Treatment of Frey's Syndrome Patients with Botulimum Toxin A

PURPOSE: Frey's syndrome is a common complication after parotid surgery and characterized by gustatory sweating and flushing in the periauricular area during meals. Although a variety of methods were proposed to prevent this postoperative problem, they were unsatisfactory. We used botulinum toxin A to treat 9 patients with Frey's syndrome and investigated the duration effect after the injection. METHODS: Nine patients became the object of study about the effect of botulinum toxins as treatment of Frey's syndrome. Age of patients ranged from 25 to 78 years (mean, 43.7 years). Six of nine patients had both symptoms of gustatory sweating and flushing. And the others had only gustatory sweating symptom. Using Minor starch iodine test, the affected skin area was detected, and it was marked by 1 cm2 sized grid appearance. After application of EMLA cream on the gustatory sweating area, botulinum toxin A was injected intracutaneously into the affected skin area (2.5 U/cm2). Patients were followed up from six to fifteen months (mean, about 12 months) and asked about improvement of their symptoms. RESULTS: The treatment with botulinum toxin A had an effect within 2 days after the injection. Six months after injection, gustatory sweating disappeared completely in all patients, and 5 of six patients who had gustatory flushing improved in their symptom. At the last follow-up, no patients complained of recurrent gustatory sweating and flushing except one. One patient, seven months after initial injection, was retreated with botulinum toxin A because of recurrence, and the result was successful. The duration of the effect after botulinum toxin A treatment was ranged from seven to thirteen months. One patient in our series experienced the upper eyelid weakness as adverse effect, but it improved spontaneously. CONCLUSION: Local injection of botulinum toxin A is an effective, safe and long-lasting method for treatment of Frey's syndrome. Hereafter, however, additional study is required to evaluate the duration effect of botulinum toxin A as to frequency in use and dosage

Predisposing factors to nipple confusion / 소아과

PURPOSE: The purpose of this study is to investigate the predisposing factors for nipple confusion by using questionnaires. METHODS: From October, 2005 to October, 2006, we performed a survey on guardians of neonates who had been admitted to the nursery at Dongguk University Medical Center and were discharged 10 to 14 days before the survey. We reviewed their medical records retrospectively. The neonates were categorized into two groups; nipple-unconfused group and nipple- confused group. RESULTS: There were 71 neonates in the nipple-unconfused group and 29 neonates in the nipple-confused group. In the nipple-confused group, 12 neonates (41.4%) had nipple-suckling experience before admission, whereas in the nipple-unconfused group, 54 neonates (76.1%) had nipple-suckling experience before admission; showing a difference that was statistically significant (P=0.001). Regarding to breast-feeding experience before admission, 11 neonates (37.9%) had experience in the nipple-confused group, whereas 49 neonates (69.0%) had in the nipple-unconfused group. This also showed a statistically significant difference (P=0.004). However, the relationship between the duration of breast-feeding prior to hospitalization was not different (P=0.151). CONCLUSION: In this study, we believe that the suckling experience and the breast-feeding of neonates before admission may be factors affecting the development of nipple confusion. This study particularly revealed that neonates who had only nipple suckling experience, regardless of breast-feeding, had less nipple confusion. Thus, allowing neonates enough time to make an attempt at nipple suckling may be helpful to prevent nipple confusion.

Closed Reduction of Nasal Bone Fracture Under the Mask Ventilation Anesthesia Using Oral Airway

PURPOSE: The majority of nasal fractures have been treated by closed reduction. And they were manipulated under local anesthesia or general anesthesia. Under the local anesthesia, patients can feel the pain and fear, so general anesthesia through the endotracheal intubation became popularized recently to treat the nasal fracture. But it has still the drawbacks of postanesthetic complication. Therefore, under the mask ventilation anesthesia using oral airway, we tried to manipulate the nasal fracture. METHODS: From July 2007 to November 2007, we worked with fifty patients that were manipulated the nasal fracture. Fifty patients were divided into two groups, general anesthesia with the endotracheal intubation group(n=25) and the mask ventilation using oral airway group(n=25). We checked up the anesthesia time, postanesthetic complication, postoperative aesthetic & functional problem of nose in two groups. RESULTS: In total operation time and sore throat frequency among the postoperative anesthetic complications, there was statistically significant difference between the mask ventilation group and the endotracheal intubation group(p0.05). And no patients complained of postoperative nasal complication such as septal deviation, septal perforation, nasal obstruction and hump nose in two groups. CONCLUSION: Through the mask ventilation using oral airway, we could reach satisfactory results in the anesthetic time and postanesthetic complication.

Outbreak of Measles among School Ages in Yeongju in 2000 / 한국역학회지

BACKGROUND: The outbreak of measles from 2000 to 2001 was the biggest epidemic since measles vaccination was introduced in Korea. Outbreak of measles in Yeongju was one of the earliest milestones of the nationwide outbreak in the year 2000. The authors investigated epidemiologic characteristics of the outbreak in this area. METHODS: The authors estimated attack rate through the investigation of all the school age cases of measles reported to local health authority between March and May, 2000. Case investigation was done to trace the source of the outbreak. One hundred seventy two cases were examined with medical examination, with interview on their clinical manifestations, and with serologic examination on the anti-measles IgM and IgG antibody. RESULTS: Overall attack rate among the school children was 4.3%, with highest attack rate in middle school students (8.5%). The outbreak began in March in middle schools, which spread to elementary and high schools. IgG was positive in 160(93.0%) cases and IgM was positive in 94(54.6%) cases, among which 90 cases (95.7%) were also positive for IgG. IgM positive cases had higher prevalence of rash (91.5%) compared to those without IgM (70.5%). Diagnostic criteria based on the clinical manifestation and contact history showed the highest sensitivity (92.6%) compared to conventional diagnostic criteria in outbreak (40.4-44.7%) CONCLUSIONS: High proportion of susceptible children in the population due to primary or secondary vaccine failure played a key role in this outbreak. Clinical manifestation was milder than classical measles and adjustment of diagnostic criteria can be helpful in the management of outbreak.

Risk Factors Related to Musculoskeletal Symptoms in Shipyard Workers / 대한산업의학회지

OBJECTIVES: The aim of this study is to determine the risk factors related to musculoskeletal disorders in shipyard workers. METHODS: A questionnaire survey was performed on 2,140 shipyard workers in a shipyard in Ulsan city. The questionnaire consisted of questions on the general characteristics, the health behavior, work type and duration, physical burden, job control, type of instruments used, posture, and musculoskeletal symptoms. Definition of musculoskeletal disorders was based on either NIOSH criteria and Kim's criteria. RESULTS: Positive rate of musculoskeletal disorders in any one part of the body was 77.2% by NIOSH criteria and 60.7% by Kim's criteria. Positive rate of the symptoms increased in workers with longer work hours, with a severe physical burden, and without any control over their job. Work with a more frequent unstable posture and for longer hours was also associated with increased musculoskeletal symptoms. Multiple logistic regression analysis showed that unstable posture and physical burden is closely related to the positive rate of musculoskeletal symptoms after controlling for age, smoking, drinking, exercise, duration of work, and job control; showing a good dose-response relationship. CONCLUSION: Inadequate posture and physical burden were the most significant factors affecting musculoskeletal disorders in shipyard workers in this study. Therefore, it will be necessary to make efforts to reduce the prevalence of musculoskeletal disorders related to a specific job, instrument, physical burden, and posture. Workers should be educated on the types and prevalence of musculoskeletal disorders, how to improve the ergonomic occupational environment and to set up preventive measures against the risk factors during work.

Evaluation of Measles Vaccine Effectiveness in a Community Outbreak / 예방의학회지

OBJECTIVE: From an analysis of a community outbreak of measles in Youngju, Gyeongbuk, in March 2000, the authors evaluated the effectiveness of the measles vaccination and its determinants to provide an epidemiologic basis for the establishment of a vaccination policy. METHODS: Information was collected regarding the vaccinations from the health records of four primary schools and through a questionnaire survey of the parents of students in two middle and two high schools (N=4638). Measles cases were surveyed from the patient list of each school and from case reports in the public health center. The attack rate and vaccine effectiveness of measles was evaluated by school; grade; frequency, region, and institution of vaccination. RESULTS: The attack rate of measles, 6.3% among the total subjects, was higher in middle school students (15.8%) than in primary (2.0%, p<0.05) and high school students (8.9%, p<0.05). The attack rate of the unvaccinated group was 4.6-fold higher than the vaccinated group in primary schools (p<0.05). Vaccine effectiveness was 83.2% among lower graders of primary schools, 34.0% among higher graders of primary schools, 26.1% in middle schools, and -7.0% in high schools. In multiple logistic regression analysis, grade in school (odds ratio, 0.77; 95% CI=0.67-0.87) and frequency of vaccination (odds ratio, 0.57; 95% CI=0.37-0.88) were significant predictors of the outcome. CONCLUSIONS: We concluded that the explosive outbreak of measles in this area resulted from both inadequate vaccination coverage and secondary failure of vaccination. There was no evidence of any effect of the cold chain system on the vaccine failure.

Epidemiologic Investigation of a Mumps Outbreak in a Middle School in Pohang, Korea: Effect of vaccination during outbreak / 한국역학회지

BACKGROUND: There was a widespread outbreak of mumps at elementary and middle schools in Pohang city in March 1999. We have carried out an epidemiologic survey to trace the source and mode of transmission of the outbreak, as well as evaluating the effect of vaccination as a measure of controlling the outbreak. METHODS: Questionnaire survey on 959 students showed that attack rate was 10.7%. There was no significant difference between genders in terms of attack rates. However, second graders outnumbered other groups as 16.9%, comparing to 8.1% among first graders and to 7.0% in the third graders. RESULTS: Cases of mumps were reported in 1998, primarily in the neighboring elementary schools. The disease was also reported earlier in 1999, sporadically. In March, however, number of the cases was sharply on the rise as the middle schools opened for a new semester. Our investigation revealed that infection stemmed from more than three different sources, particularly in the classes of second graders, and then spread to all students, corresponding to the distance between students. Effect of vaccination during the outbreak was pretty good: attack rate of the group vaccinated since May 1st, considering the maximum latent period of infections (21 days), was 0.8%, comparing to 5%. The efficiency of vaccination marked 84.8%.(95% confidence interval 79.66-89.94) Although the authors recommended the students to wear flue masks and wash their hands as often as possible to screen infections among the students, it turned out that such measures had little effect for the prevention of spread. CONCLUSIONS: The number of mumps cases dropped remarkably among vaccinated the students the prevalent period of the disease. Authors concluded that is effective to control the outbreak if it is done at early stage.