We investigated the biomechanical significance of bone bruises in patients with patella dislocation. Thirty-four patients with acute dislocation of the patella were studied. Redislocations were excluded. There were 11 men and 20 women with a mean age of 18 years at the time of injury. Bone bruises were noted at the periphery of the lateral femoral condyle in 22 patients (65%) and in 10 cases (29%) at the medial patellar facet. The sulcus angle in patients with bone bruises at the lateral femoral condyle was significantly greater and tibiofemoral rotation at the knee was significantly smaller than in patients without bone bruises. In knees with small tibiofemoral rotation, a large lateral displacement force applied into the knee joint is needed to displace the patella. The flat femoral trochlea groove, however, can not reduce the force, resulting in hard impaction between the medial patella facet and the lateral femoral condyle producing bone bruises.

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We performed 41 laparoscopic nephrectomies for patients with renal cancer between April 2007 and March 2009. Among those cases, 18 patients were 70 years or older, and 5 were 80 years or older.
We compared surgical duration, volume of blood loss, interval until resumption of liquid intake, interval until resumption of solid food intake and duration of hospital stay between men aged younger than 80 years old and those aged 80 years or older. Excluding the interval until resumption of liquid intake, there were no significant differences between those two groups.
We concluded that laparoscopic nephrectomy could be safely performed and was less invasive for elderly patients.

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Objectives : The purpose of this study was to identify needs in care management for end of life care patients from care manager's perspective, and practice of home care management. Methods : Subjects were 77 care managers for the home care patients who were trained in "A" prefecture and agreed to participate in the survey. The questionnaire examined the care manager's involvement in end of life care, use of service, understanding of care management needs, and intervention by end of life stage. Results : As a result, intervention by the care manager occurred most frequently in the stable stage followed by the introductory and clinical death stages. Establishing a care system was highest in understanding the need and its implementation. More than half of the care managers reported difficulties in end of life care management. Conclusion : These results differ by age, experience year and occupation of the care manager, thus a new system is needed for training and improving quality in care management.

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Background and Purpose : The purpose of this study is to understand the significant effect on fetus and young children by women who smoke during pregnancy and child-raring and to support stop smoking in order to prevent secondary smoke inhalation by infants & toddlers. Methods : Questionnaires were sent to 2,849 mothers whose children, ages from four months to three and a half, were subject to a medical examination. Survey period was done in City A from April through November of 2006. Results : Valid response rate was 50.3%. The rate of smoking mothers was 12.8%, of whom 46.7% continued smoking and 51.1% quit smoking during gestation. As a result of logistic regression analyses, "mothers smoking in front of their children" were significantly affected with the following four categories : whether their family members smoke in front of their children ; the number of cigarettes20they smoke per day ; the age when they started smoking ; and the ages of their children. Conclusion : 51.1% of the smokers re-started smoking after childbirth. Significant relation was observed between "mothers smoking in front of their children" and the following four categories : whether their family members smoke in front of their children ; the number of cigarettes they smoke per day ; the age when they started smoking ; and the age of their children.

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Background and Purpose : Families of cancer patients, like the patients themselves, are tormented by the current problems and future prospects. The purpose of the present study is to compile the results of past intervention studies on families of cancer patients and classify them according to criteria of Priority Symptom Management (PRISM) Levels of Evidence so that the current trends and future issues may be clarified. Subjects and Methods : For databases, PubMed and CINAHL were used and the search period was set between 2000 and March 2009. For search terminology, "family of cancer patient," "educational intervention" or "psychology intervention" was selected. The retrieval was limited to nursing journals and hand searches were added to the retrieved articles. The Results were compiled and their evidence levels were classified, while referring to PRISM by Ropka et al. Results : In total, 27 articles were analyzed. Their evidence levels were arranged as follows in a descending order : 1 : 2 articles, 2 : 8 articles, 3 : 14 articles and others : 3 articles. Conclusion : When compared with a prior study by Jeanie et al., the intervention studies introduced since 2000 indicated the following developments : (1) sufficient randomization ; (2) adoption of reliable scales for determining outcomes ; and (3) depiction of an intervention model interpreting a family as a system.

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Superior mesenteric artery (SMA) dissection is rare. We herein report about a case of SMA dissection which required resection of a large amount of the small intestine and the colon. A 59-year-old male with vague lower abdominal pain and diarrhea was admitted to our hospital. An erect abdominal X-ray showed niveau. His condition deteriorated and on the fifth day from the onset, an enhanced computed tomography (CT) revealed the SMA was dissected along 3 cm of its length from its origin, and the blood supply to the small intestine was shuttered in association with false lumen formation. Finally, the patient was necessitated an emergency surgery. A grayish ischemic small intestine and ascending colon were seen along with a moderate amount of ascites. The ischemic part of the intestine was resected. Pathological findings revealed coagulation necrosis with inflammatory cell infiltration, blood congestion, and hemorrhage. This coagulation necrosis was compatible with hemorrhagic necrosis due to intestinal ischemia. In conclusion, enhanced CT was available for detecting SMA dissection. If a patient with acute abdomen of unknown origin is encountered, SMA dissection should be ruled out, because ischemic intestine due to SMA occlusion is time-dependent and life-threatening. Furthermore, in the case of extensive bowel resection, the management of short bowel syndrome is thought to be essential.

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