A novel photonumeric hand grading scale for hand rejuvenation

BACKGROUND: Few scales are currently available to evaluate changes in hand volume. We aimed to develop a hand grading scale for quantitative assessments of dorsal hand volume with additional consideration of changes in skin texture; to validate and prove the precision and reproducibility of the new scale; and to demonstrate the presence of clinically significant differences between grades on the scale. METHODS: Five experienced plastic surgeons developed the Hand Volume Rating Scale (HVRS) and rated 91 images. Another five plastic surgeons validated the scale using 50 randomly selected images. Intra- and inter-rater agreement was calculated using the weighted kappa statistic and intraclass correlation coefficients (ICCs). Paired images were also evaluated to verify whether the scale reflected clinical differences. RESULTS: The intra-rater agreement was 0.95 (95% confidence interval, 0.922–0.974). The interrater ICCs were excellent (first rating, 0.94; second rating, 0.94). Image pairs that differed by 1, 2, and 3 grades were considered to contain clinically relevant differences in 80%, 100%, and 100% of cases, respectively, while 84% of image pairs of the same grade were found not to show clinically relevant differences. This confirmed that the scale of the HVRS corresponded to clinically relevant distinctions. CONCLUSIONS: The scale was proven to be precise, reproducible, and reflective of clinical differences.

Significance and prospect of workers health center

Systematic health management is crucial in small-sized enterprises since the number of enterprises and their employees make up a large proportion of all businesses and they account for the majority of industrial accidents and occupational illnesses. The Korean government had operated the Banwol-Sihwa Regional Center for Occupational Health to provide occupational health services and chronic disease management to the workers in small-sized enterprises as a pilot health promotion project from 2007 to 2010. Since then, Gyeonggi-seobu workers health center (WHC) was established in 2011 to provide physician care for small-sized enterprises through the Industrial Accident Compensation Fund. The WHC has provided basic occupational health services including health promotion activities to prevent work-related diseases. Core strategies of the WHC were networking with regional health resources, post-examination care for workers with abnormal findings in health screenings, the operation of branch offices for better accessibility, and services for vulnerable workers including immigrant, women, and elderly workers. An evaluation of WHCs conducted in 2012 showed excellent performance in terms of cost-effectiveness, high satisfaction, and intent toward continuous use among visitors. For the advancement of WHCs, visiting services to the worksites have to be integrated adequately with services in WHCs, and more subsidiary centers need to be established for better accessibility. Moreover, the expansion of the service items and development of specialized health programs are needed. Measures should be considered to systematically collect health data and identify workplace risk factors to improve the quality of post-examination care.

An Assessment of the Needs and the Affecting Factors for Small Scale Enterprise Worker's Health Centers / 대한산업의학회지

OBJECTIVES: The aim of this paper is to assess the needs and roles of the Worker's Health Centers employed by small scale enterprises by investigating the requested services made to this type of Worker's Health Center. METHODS: The population of this research was taken from 1,145 business owners or managers of manufacturing companies employing less than fifty people in six industrial estates. Stratified sampling was used. Individual interviews were performed to assess the conditions and needs of these enterprises using a structured questionnaire and professional interviewers. RESULTS: According to the questionnaire survey, 941(82.2%) of the enterprises wish to use a Worker's Health Center. 946(83.3%) of the enterprises preferred an 'Expert visit to the enterprise or mixed' for the Delivery type. 486(42.4%) of the enterprises preferred the 'in the center of industrial complex' for the location of the Worker's Health Center. 789(69.1%) of the enterprises preferred 6-10 PM for the available open hours. A multiple regression analysis revealed a significantly positive association regarding the intention of using a Worker's Health Center and the Gyeonggi-Banwol (OR 2.49) or Gwangju-Hanam(OR 4.24) for the region. Compared to enterprises employing 1-4 worker, 30-49 worker enterprises show a 3.33 fold preference (95% CI 1.80~6.12) for the use of a Worker's Health Center. CONCLUSIONS: Generally, the intention regarding the use of a Worker's Health Center was high, Considering the time and spatial limits inherentin small scale enterprises, the 'expert visit to the enterprise' paradigm is important. It should be noted that when providing the service, a customized approach is necessary, determined by size, region, industry, and scale of the business, through the assessment of the small scale enterprises and the nature of the work environment when designing a Worker's Health Center operation.

Palatoplasty with AlloDerm(R) Graft

Recently, Furlow's palatoplasty, intravelar veloplasty and other procedures have become popular for cleft palate. However, the push-back method holds an important position among the various palatoplasties because it is safe and reliable. Previous reports have shown that normal or nearly normal speech is attained in between 70 and 90 percent of the patients of push-back method. Early palatoplasty might influence maxillary growth more than late palatoplasty. There are some problems after operation of push-back method. The raw surface causes bleeding, pain, poor oral intake, growth interference for scar contracture and tension on central suture line. This lateral defect can be closed directly but tension on central suture area is increased, and the risk of wound dehiscence is increased. We used AlloDerm(R) graft for covering of this bony exposed raw surface on both lateral palatal area. Thus exposed surface was protected by AlloDerm(R) graft and then patient suffered from pain less than conventional method. The bony surface was compressed by AlloDerm(R) and bleeding was not found after AlloDerm(R) graft. Patient was not irritable and intake of patient was good after operation. The recovery was faster than conventional push-back method.

Value of Hepatoduodenal Ligament and Retropancreatic Lymph Node Dissection (D2+alpha) in Gastric Cancer Surgery

PURPOSE: Obstructive jaundice is a rare presentation in patients undergoing curative gastrectomy for gastric cancer. It is most commonly caused by lymphatic metastasis in the lymph nodes around the head of the pancreas and hepatoduodenal ligament, especially when advanced gastric cancer is located in the pyloric antrum. This incidence suggests that extended and systemic lymph node dissection maybe reduce the risk of the development of obstructive jaundice after gastrectomy. In this study we tried to evaluate the effectiveness of D2+alpha lymph node dissection in preventing obstructive jaundice during gastric cancer treatment. METHODS: Twenty-four patients who underwent D2+alpha lymph node dissection in the course of gastric cancer treatment at Asan Medical Center between June 1995 and May 1997 were retrospectively analyzed on the basis of medical records. The mean age of the patients was 54 years, and the male to female ratio was 3.9: 1. RESULTS: Four patients (16.6%) developed complications (Ed-perhaps you wish to insert here, "other than tumor recurrence") but these were not serious. Tumor recurrence developed in 11 patients, and obstructive jaundice was revealed in one (4.1%) of these. All recurrent patients were more than stage III (Ed-confirming that this means stage 4 or more) with the most common recurrence site being the peritoneum (72.7%). The mean duration from operation to recurrence and from recurrence to death was 13.9 months and 7.9 months, respectively. CONCLUSION: It is possible (Ed- or slightly stronger, "It is apparent") that D2+alpha dissection provides no benefit in preventing obstructive jaundice, compared with other reports (Ed- i.e. 'in comparison with other studies'. I wonder if you don't intend, "compared with the efficacy of other treatment modalities"), and that the most common site of recurrence was the peritoneum.

Ventilating Tube Method using IV Line During Closed Reduction of Nasal Bone Fracture

Recently the nasal packing after closed reduction of nasal bone fracture becomes popular procedure. However the nasal packing has adversed effects, which are nasal obstruction, discomfort, swallowing difficulty, nausea, reduction of middle ear pressure, possibility of middle ear effusion and aggravation of sinusitis, etc. During closed reduction, we inserted IV line (Safti set, Boin medica, Korea, 4mm internal diameter) in both nasal inferior meatus for ventilation. IV line could be obtained easily without cost in hospital. The flow of air was satisfactory subjectively and air resistance were tolerable. This method is applied easily without any cost and comfortable for patients.

New Technique of Flexor Tendon Repair with Endoscopic Exploration

Repair of injured tendon especially is still a difficult problem in hand surgery. The challenge is to restore the gliding mechanism of the tendon. Despite increasing knowledge of tendon healing and subsequently better postoperative result, the problem formation of adhesion between the tendon and its direct surroundings remains. It is now agreed that primary repair of both flexor tendon is the treatment of choice with preservation and resto-ration of the tendon sheath. The flexor tendon sheath plays an important role in flexor nutrition, especially for the volar part of the tendon, by secreting the synovial fluid. Although data to data are indications that it will lead to fewer adhesions. Tendon sheath are sometimes restored by autologous graft. It is excellent management that the tendon sheath and pulley system are restored during tendon repair. The method of minimal injury to tendon sheath and pulley is better than restoration of that. The exploration of divided tendon through wound margin with endoscope minimizes sheath and pulley injuries. The blunt extraction of divided tendon from invisible wound site is a risky method for exploration of tendon. This endoscopic method is less traumatic, causes less pain, and requires a minimal incision. And the patient with endoscopic tenorrhaphy can exercise immediately because less operation site discomport and can be discharged early. The new tenorrhaphy technique using endoscope is expected to give better result than conventional method.

3-dimensional one point foxation with x-shaped miniplate in the cases of the zygomatic fracture

Recently the internal rigid fixation with plates and screws became popular procedure. In the cases of the zygomatic fracture, it is sufficient to fix more than 2 point in many studies. Therefore, the internal rigid fixation requires the aggressive incision to expose the zygoma, such as coronal incision. Since many patients are afraid of this aggressive operation, we have provided a simple and effective method which is a 3-dimensional one point fixation on the zygomaticofrontal suture with X-shaped(6-hole) miniplate for the treatment of zygomatic fractures. From March 1995 to september 1995, we treated 13 cases of zygomatic fractures by open reduction and X-shaped miniplate fixation on the zygomaticofrontal suture. The results were as follows: 1) plane to plane contact on each side of the fracture with one point X-shaped miniplate. 2) 91.8% correction on Water's views, and 93.3% correction on zygomatic arch view with one point fixation. 3) patients were satisfied with these procedures because of minimal incision, mild edema and low operation price (short operation & anesthetic time, one plate & 6 screws cost).

Outcome Following Severe Head Injuries in Children

Accidents cause more than half of all childhood deaths, despite early diagnosis and proper treatment. It has showed still high mortality and morbidity. We analyzed the results of treatment of 50 severely head injured children who were admitted to the department of neurosurgery. Wonkwang University Hospital from January, 1984 to March, 1988 and evaluated prognostic factors affecting the outcome. Our conclusions are as follow: 1) We experienced the high mortality in children no more than five years of age. 2) The Glasgow coma scale on admission was a reliable indicator predicting the outcome in severe head injury. 3) The neurological features such as papillary light reflex, oculocephalic reflex and motor respons were good indicators of outcome. 4) Therer was no significant difference in outcome between diffuse brain injury and intracranial mass lesion. 5) The diffuse brain swelling on brain CT scan worsened the outcome. 6) The mortality rate increased in children associated with viscus rupture in head inujury. 7) The overall outcome showed 38% of good recovery, 20% of moderate disability, 10% of severe disability, 4% of vegetative state, and 28% of death.