BACKGROUND: Percutaneous cannulation of internal jugular vein is difficult in pediatric patients because of its small size and anatomic variation. The aim of this study is to investigate cross-sectional area and relative anatomy of right internal jugular vein with respect to the carotid artery in two approaches and thereby to find ideal cannulation site in young children. METHODS: The cross-sectional area of right internal jugular vein and the degree of the carotid artery overlap was evaluated in 47 children using ultrasound at two levels; 1) at the cricoid cartilage (high approach) and 2) at the junction of the two heads of the sternocleidomastoid muscle (low approach). RESULTS: The cross-sectional area was significantly larger by about 28.8% in the low approach than that of the high approach (P < 0.01). The internal jugular vein was partially overlapping the carotid artery in 48.9% and completely overlapping in 42.6% in the low approach and in 44.7% and 34.0% in the high approach respectively. The carotid artery overlap was significantly higher in the low approach when compared with the high approach (P < 0.02). CONCLUSIONS: In terms of cross-sectional area, the low approach with larger size is optimal for internal jugular vein cannulation. Although the degree of the carotid artery overlap was higher at the low approach, the internal jugular vein was partially or completely covering the carotid artery in most patients in both approaches. When attempting to cannulate the internal jugular vein, clinicians should be aware of the large anatomic variations.
Anatomic Variation ; Carotid Arteries ; Catheterization ; Child ; Cricoid Cartilage ; Head ; Humans ; Jugular Veins ; Muscles

Intensive insulin therapy effectively delays the onset and slows the progression of nephropathy in patients with IDDM. TGF- 0 has recently been implicated in the pathogenesis of diabetic nephropathy. We evaluated the effects of different level of glucose control with insulin therapy on the progression of diabetic nephropathy in age-matched control rats(C) and 3 groups of streptozotocininduced diabetic rats', high blood glucose diabetic rats without insulin therapy(HG), rnoderate glucose diabetic rats with insulin therapy(MG), and normal glucose diabetic rats with intensive insulin treatment (NG). Glomerular volume(VG) was measured using Image-Pro morphometric software, glomerular TGF- Bl mRNA expression by in situ hybridization, and glomerular expression of TGF-8 and type IV collagen proteins by immunohistochemical staining. VG was significantly higher in HG than in other groups in 12 weeks. Kidney weight(KW) was the highest while the body weight the lowest in HG of all groups in 12 weeks. Daily urine albumin excretion (UAE) increased with time in all groups but was significantly larger in HG than in all other groups in 12 weeks. MG also had significantly larger UAE than C in 12 weeks. There was no difference in VG, KW, and UAE between NG and C. Glomerular TGF-Bl mRNA expression was significantly higher in HG than in all the rest of the groups in 4 and 12 weeks. Glomerular expression of TGF-B and type IV collagen proteins was proportional to the levels of blood glucose, being the highest in HG in 12 weeks. There was little or no expression of TGF-0 1 mRNA and protein or type IV collagen protein in NG. Thus these results support the view that high blood glucose is the prerequisite for glomerular injury in diabetes mellitus and that the glomerular injury in diabetes mellitus is mediated, in part, by TGF-01 and suppressed by glucose control.
Animals ; Blood Glucose* ; Body Weight ; Collagen Type IV ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diabetic Nephropathies* ; Glucose ; Humans ; In Situ Hybridization ; Insulin* ; Kidney ; Rats ; RNA, Messenger

PURPOSE: This study was designed to determine whether transabdominal ultrasound can detect different hepatic stiffness between patients with cirrhosis and control subjects. MATERIALS AND METHODS: Sevent-three patients (Child-Pugh class A stage) with liver cirrhosis and 57 control subjects were included in this study. All patients were subdivided arbitrarily into two groups: early cirrhosis (n = 53) and overt cirrhosis (n = 20). Two sagittal images of the left lobe of the liver were obtained in the left hepatic vein level during the resting state and at full inspiration while pushing their belly out, by abdominal US (i.e., resting and stress image). The length between the inferior hepatic angle and the midpoint of the liver dome was measured in all images for the evaluation of liver distortion. The elongation was calculated by a formula: (L2-L1/L1) x 100(%); where L1 and L2 are the length of the liver for both the resting and stress image. The calculated elongated length (L2-L1, EL) and elongation rate were compared between cirrhotic patients and control subjects. RESULTS: For the control subjects, early cirrhosis, and overt cirrhosis groups, the mean ELs (elongation rate) were 2.34+/-0.98 cm (30.2+/-13.2%), 1.18+/-0.73 cm (14.9+/-9.5%) and 0.53+/-0.54 cm (6.3+/-6.6%), respectively. This difference among the three groups was statistically significant (p < 0.05). A possible best cut-off value of liver elongation rate is 17% for the prediction of cirrhosis (sensitivity: 90%, specificity: 75.3%). CONCLUSION: The liver of patients with liver cirrhosis is stiffer than that of control subjects. Calculation of the elongation rate in the left lobe of the liver during a respiratory maneuver may be used as an ancillary method of US for the evaluation of liver cirrhosis.
Fibrosis ; Hepatic Veins ; Humans ; Liver ; Liver Cirrhosis ; Respiration

PURPOSE: The aim of this study was to identify factors associated with new graduate nurses' choices of local hospitals. METHODS: Participants were 526 new graduate nurses from one of five universities located in Busan, Ulsan or Gyeongnam. The new graduates completed a self-report questionnaire survey during February and March, 2016. The questionnaire included questions about choices of local hospitals, satisfaction with nursing major, nursing professionalism and anticipated nursing practice environment. Multiple logistic regression analysis was conducted to identify factors associated with the new graduate nurses' choices of local hospitals. RESULTS: Of the participants, 86.3% had their first jobs in their nursing school region (local hospitals). The choice of local hospitals among new graduate nurses was related to region of origin, type of nursing school, grade point average, and anticipated nursing practice environment. CONCLUSION: Local hospitals need to enhance the nurse practice environment and provide institutional benefits to new graduate nurses who choose local hospitals. For quality nursing care, reducing the geographical gap and improving policy is necessary.
Busan ; Career Choice ; Logistic Models ; Nursing ; Nursing Care ; Professionalism ; Schools, Nursing ; Ulsan

BACKGROUND: Although it is known that patients wth peripheral vascular disease are at high risk for coronary arterial disease, however, it has not been determined that patients with coronary artery disease(CAD) correlates with peripheral vascular disease(PVD). This study was designed to determine the prevalence and clinical characteristics of peripheral vascular disease(PVD) in patients with coronary artery disease(CAD). METHODS: A total of one hundred seventy-eight patients with CAD confirmed by coronary angiogram(145 male, age 58.5+/-10.1) were included in this study from February 1992 to May 1994. Coronary and peripheral angiograms were performed in all patients and the patients were divided into two groups; patients with PVD dand patients without PVD. Clinical characteristics were compared between two groups. RESULTS: Peripheral vascular disease was present in 49 patients(27.5%) among 178 CAD patients. The mean age of patients with PVD was significantly older than that of patients without PVD. The hypertension was statistically significant difference between two groups(P<0.05). There were no major differences in the number of risk factors or number of stenotic coronary arteries in patients with and without PVD. CONCLUSION: The prevalence of PVD in patients with CAD was high and it is reasonable to state that most common risk factors for coronary and peripheral atherosclerosis were age, hypertension and obesity.
Atherosclerosis ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Hypertension ; Male ; Obesity ; Peripheral Vascular Diseases* ; Prevalence ; Risk Factors

Orbital neuroblastoma is the most common childhood metastatic malignant tumor almost always originating from the adrenal medulla; orbital primary origin is very rare. The authors experenced a case of orbital neuroblastoma. The patient was 3 year old Korean female child who was in apparently good health and no abnormalities noted of physical examminations when she developed ecchymosis of right lower lid. About two week later, she quickly developed a growing mass in the right lower orbital soft tissue. The mass was removed and his topathologically diagnosed as neuroblastoma. Radiotherapy was recommended. About 4 months bter, the patient was readmitted because of recurrence of orbital mass 3t the same site. At surgery, tumor was found invading inner and flooe wall of the orbital bone. The patient died of poor course of the disease, about one year after the onset of symptoms. It was suggested that this case was represented metastatic orbital neuroblastoma on histopathological base, but authors were unable to determine the primary site. A brief review of the related literatures is present.
Adrenal Medulla ; Child ; Child, Preschool ; Ecchymosis ; Female ; Humans ; Neuroblastoma* ; Orbit* ; Radiotherapy ; Recurrence

OBJECTIVE: The purpose of this retrospective study was to report the outcome of the endovascular treatment of eight patients with eight saccular posterior inferior cerebellar artery (PICA) aneurysms. MATERIALS AND METHODS: Over the last seven years (1999-2006), eight consecutive patients with saccular PICA aneurysms were treated by endovascular methods. Five of the aneurysms were presented with subarachnoid hemorrhaging, whereas three were discovered incidentally. Four of the aneurysms (3 ruptured and 1 incidental) were treated by intrasaccular coiling, whereas the remaining four (1 ruptured and 3 incidental) were treated by vertebral artery (VA) occlusion. RESULTS: Of the four aneurysms treated by intrasaccular coiling, three were completely packed with coils and one was partially packed. In three of four patients who underwent vertebral artery occlusions, follow-up digital subtraction angiographies demonstrated thrombosed aneurysms and PICA. No procedure-related morbidity occurred and no re-bleed was encountered during a follow-up examination (mean; 31 months). CONCLUSION: As a result of this study, we found that the endovascular management of saccular PICA aneurysms should be considered as safe and effective.
Adult ; Aged ; Aneurysm, Ruptured/radiography/*therapy ; Cerebellum/blood supply/*radiography ; Cerebral Angiography ; Embolization, Therapeutic/*methods ; Female ; Humans ; Incidental Findings ; Intracranial Aneurysm/radiography/*therapy ; Male ; Middle Aged ; Retrospective Studies ; Subarachnoid Hemorrhage/radiography/*therapy ; Treatment Outcome

Segmental neurofibromatosis is rare disorder characterized by cafe-au-lait macules and neurofibromas, or only neurofibromas, limited to one region of the body. Typically the neurofibromas are unilateral and are occupied a single dermatome in most patients. We report a 62-year-old man with segmental neurofibromatosis on the right knee in the distribution of dermatomes L3 and L4.
Humans ; Knee* ; Middle Aged ; Neurofibroma ; Neurofibromatoses* ; Neurofibromatosis 1

No abstract available.
Angiofibroma*

OBJECTIVES: To assess the availability of the glycophorin A (GPA) assay to detect the biological effect of ionizing radiation in workers exposed to low-doses of radiation. METHODS: Information on confounding factors, such as age and cigarette smoking was obtained on 144 nuclear power plant workers and 32 hospital workers, by a self-administered questionnaire. Information on physical exposure levels was obtained from the registries of radiation exposure monitoring and control at each facility. The GPA mutant assay was performed using the BR6 method with modification by using a FACScan flow cytometer. RESULTS: As confounders, age and cigarette smoking habits showed increasing trends with GPA variants, but these were of no statistical significance. Hospital workers showed a higher frequency of the GPA variant than nuclear power plant workers in terms of the NO variant. Significant dose-response relationships were obtained from in simple and multiple linear regression models. The slope of the regression equation for nuclear power plant workers was much smaller than that of hospital workers. These findings suggest that there may be apparent dose-rate effects. CONCLUSION: In population exposed to chronic low-dose radiation, the GPA assay has a potential to be used as an effective biologic marker for assessing the bone marrow cumulative exposure dose.
Biomarkers* ; Bone Marrow ; Glycophorin* ; Linear Models ; Nuclear Power Plants ; Surveys and Questionnaires ; Radiation, Ionizing ; Registries ; Smoking