OBJECTIVE: To find out the factors affecting medication discontinuation in patients with overactive bladder (OAB) symptoms. METHODS: The clinical data of 125 patients with OAB symptoms who had taken antimuscarinics and behavioral therapy were retrospectively reviewed. Antimuscarinics related outcomes were evaluated by an independent observer with telephone interview. All patients were asked about duration of medication and reason of continuation or discontinuation of antimuscarinics. To determine pre-treatment factors predicting self-report discontinuation of antimuscarinics, variables of only those with P-values <0.25 on the univariate analysis were included in the Cox proportional hazard modeling. RESULTS: Mean follow-up was 39.6 months and the proportion of discontinuation of antimuscarinics was 60.0% (75/125). The mean duration of medication was 21.2 months in the continuation group and 3.3 months in the discontinuation group. The reasons of discontinuation of antimuscarinics were improved OAB symptoms (46.7%), tolerable OAB symptoms (33.3%), no change of OAB symptoms (1.3%), side-effects (8.0%) and no desire to take long-term medication (10.7%). The variables affecting remaining cumulative probability of antimuscarinics were age, history of anti-incontinence surgery or vaginal surgery, and having stress predominant urinary incontinence on urodynamic study. CONCLUSION: The lower rate of cumulative continuation of antimuscarinics encourages us to give a more detailed counseling and education to the patients with OAB symptoms before prescription. And explorations about newer agent and non-pharmacologic treatment with good efficacy and lower side-effects are needed.
Counseling ; Education ; Follow-Up Studies ; Humans ; Interviews as Topic ; Muscarinic Antagonists ; Prescriptions ; Proportional Hazards Models ; Retrospective Studies ; Urinary Bladder, Overactive* ; Urinary Incontinence ; Urodynamics

No abstract available.
Pregnancy*

We reported a case of atypical thymic carcinoid tumor with ectopic ACTH syndrome which was proved by the presence of intracytoplasmic ACTH in the tumor cells using PAP method and electron microscopy. The patient was a 43-year-old housewife who was referred with Cushing's syndrome of unknown origin, and subsequantly followed by many disabling symptoms including, diabetes mellitus and electrolyte imbalance for which bilateral adrenalectomy was carried out. Thereafter, rapid rise in serum ACTH level and hyperpigmentation were followed. Pituitary irradiation was done under the impression of Nelson's syndrome despite of lacking evidence of pituitary tumor, but high serum ACTH persisted. Seven months after pituitary irradiation, two anterior mediastinal masses were first noticed and removed. Immunohistochemical and ultrastructural studies confirmed this neoplasm as a ACTH producing spindle cell variant of atypical thymic carcinoid tumor. When dealing with a patient who developed Nelson's syndrome-like phenomenon without apparent pituitary tumor, the possibility of ectopic ACTH syndrome caused by thymic carcinoid should be considered.

Background & PURPOSE:Since the 1970's the rate of breast-feeding has decreased significantly. The Korean National Institute of Health reported that the rate of breastfeeding was 68.9% in 1982 and 14.1% in 1997. There are many influencing factors including: the lack of education and information on breast feeding, lack of faith in breast feeding, increment of the rate of working, lack of encouragement by supporters in difficult situations, and nurses' low level of knowledge about breast feeding. Such a lack of knowledge and support of breast-feeding at home by family members create another dilemma to the problem of breast-feeding. If problems arise and family members are unable to provide assistance due to the deficiency of knowledge, mothers show a tendency to abandon breast-feeding. The purpose of this research is to find out the rate of breast-feeding practice by time sequence of 1 week, 6 weeks and 12 weeks after birth and influencing factors on breast-feeding practice centered on the postpartal women who were 3discharged from one hospital, which is located in Seoul and provides simple breast-feeding education and continuous postnatal telephone consultation. Methodology: The subjects of this research were 54 women who gave birth in a hospital located in Seoul from 1 March 2000 to 31 April 2000. After birth the subjects were educated individually about breast-feeding and telephone consultations were conducted. On the 1st week, 6th week, and 12th week, the subjects were surveyed about their breast-feeding practice rates and methods by telephone. Results: 1) Complete breast-feeding rate: Within one week after birth, the subjects showed 64.2% complete breast-feeding rate. Within 6 weeks, 39.6%, and 12 weeks, 34.1%. 2)Partial breast-feeding rate: Within one week after birth, the subjects showed 32.1% partial breast-feeding rate. Within 6 weeks, 39.6%, and 12 weeks 15.1%. 3)Complete bottle-feeding rate Within one week after birth, the subjects showed 1.9% complete bottle-feeding rate. Within 6 weeks of giving birth 15.1%, and 12 weeks 17.0%. These results show that individual education about breast-feeding and continuous postnatal telephone consultation influenced on the practice of breast-feeding. On considering the reality of the hospital situation in which nurses could not operate education program due to the work-load, it is necessary to find out selectively those mothers who are unable to breast feed and provide education individually and continuous support by telephone follow up. Futhermore, the active role of lactation nurse specialist and their efficient management of breast-feeding for the successful practice is required.
Breast ; Breast Feeding ; Education* ; Female ; Follow-Up Studies* ; Humans ; Lactation ; Mothers ; Parturition ; Referral and Consultation ; Seoul ; Specialization ; Telephone*

A total of 672 surgically resected gastric carcinomas were reviewed, and fourteen cases(2.1%) of "gastric carcinoma with lymphoid stroma" were identified. The tumor was located mostly in cardia and body portion(86%). Thirteen patients one was lost to follow up were alive without recurrence of tumor. Grossly, this carcinoma was characterized by an expanding growth pattern or a multinodular pattern. Histologically, this carcinoma showed an irregular trabecular and alveolar arrangement and densely infiltrated lymphoid cells with lymph follicles. The tumor cell nests were widely separated by non-desmoplastic lymphoid stroma. On immunohistochemical study, T cells were evenly distributed throughout the tumor lesion with intimate contact with individual carcinoma cells, but B cells were mainly present within the germinal centers of lymph follicles. Thus, the organized immune response combined with cell mediated and humoral immunities against the carcinoma cells may be a defense mechanism of the host in this type of gastric carcinoma.

To obtain better information on fibrotic tissue of urethral stricture, we performed spongiosography in 26 patients who were already diagnosed as urethral stricture by retrograde urethrogram. All patients were well tolerated and no side effects were encountered. Spongiosography allows for an exact assessment of the urethral tissue damage and extent of stricture in the bulbous and penile urethra. We think that spongiosography may help to decide the appropriate treatment or to decrease the recurrence rate of the urethral stricture.
Constriction, Pathologic ; Humans ; Recurrence ; Urethra ; Urethral Stricture*

PURPOSE: Macrolide-resistant Mycoplasma pneumoniae pneumonia (MPP) is characterized by prolonged fever and radiological progression despite macrolide treatment. Few studies have examined serum procalcitonin (PCT) level in children with MPP. We aimed to investigate the association of acute inflammation markers including PCT with clinical parameters in children with MPP. METHODS: A total of 147 children were recruited. The diagnosis of MPP relied on serial measurement of IgM antibody against mycoplasma and/or polymerase chain reaction. We evaluated the relationships between C-reactive protein (CRP), PCT, and lactate dehydrogenase (LDH) levels and white blood cell (WBC) counts, and clinical severity of the disease. We used multivariate logistic regression analysis to estimate the odds ratio for prolonged fever (>3 days after admission) and hospital stay (> 6 days), comparing quintiles 2–5 of the PCT levels with the lowest quintile. RESULTS: The serum PCT and CRP levels were higher in children with fever and hospital stay than in those with fever lasting ≤ 3 days after admission and hospital stay ≤ 6 days. CRP level was higher in segmental/lobar pneumonia than in bronchopneumonia. The LDH level and WBC counts were higher in children with fever lasting for >3 days before compared to those with fever lasting for ≤ 3 days. The highest quintile of PCT levels was associated with a significantly higher risk of prolonged fever and/or hospital stay than the lowest quintile. CONCLUSION: Serum PCT and CRP levels on admission day were associated with persistent fever and longer hospitalization in children with MPP.
Bronchopneumonia ; C-Reactive Protein ; Child* ; Diagnosis ; Drug Resistance ; Fever* ; Hospitalization ; Humans ; Immunoglobulin M ; Inflammation ; L-Lactate Dehydrogenase ; Length of Stay ; Leukocytes ; Logistic Models ; Mycoplasma pneumoniae ; Mycoplasma* ; Odds Ratio ; Pneumonia ; Pneumonia, Mycoplasma* ; Polymerase Chain Reaction ; Risk Factors*

It is important to consider the fetal, uteroplacental, and maternal issues when choosing anesthetic technique for fetal surgery. The twin reversed arterial perfusion (TRAP) sequence, or the acardiac anomaly, occurs in 1:100 monozygous multiple pregnancies and in 1:35,000 births. The TRAP sequence is characterized by placental vascular arterio-arterial anastomosis between twin fetuses, one an acardiac/acephalic twin that receives its blood flow from the normal pumping twin, thereby endangering the normal twin by high output cardiac failure. The acardiac twin is nonviable, and perinatal mortality in the pump cotwin exceeds 50% because of cardiac failure and prematurity. This can be managed by fetal surgery. We report on a patient with a 26-wk gestation complicated by an acardiac/acephalic fetus anesthetized for surgical umbilical cord ligation.
Anesthesia* ; Female ; Fetus ; Heart Failure ; Humans ; Ligation ; Parturition ; Perfusion* ; Perinatal Mortality ; Pregnancy ; Pregnancy, Multiple ; Umbilical Cord

This study was conducted in order to investigate the association between picky eating behaviors of preschool children and growth outcomes. In this study, picky eating behaviors were defined as containing four constructs of 'eating a small amount (ES),' 'neophoic behavior (NB),' 'refusal of specific food groups (RF),' and 'preference for specific food-preparation methods (PP).' A 7-point scale was used for the multi-item questionnaire, which consisted of 21 items (three items for ES, two items for NB, nine items for RF, and seven items for PP), in order to evaluate picky eating behaviors of children. Subjects were recruited among visitors at a medical clinic in Seoul. A total of 150 self-administered survey responses from parents of preschool children were analyzed in order to investigate the association between picky eating behaviors of preschool children and growth outcomes. Height for age (HFA) and weight for height (WFH) z-scores were used for assessment of preschool children's growth. The prevalence of ES, NB, RF, and PP was 44%, 57%, 73%, and 53%, respectively. Children with ES had lower HFA (p < 0.05) and WFH (p < 0.0001) than those without ES, while children with NB, RF, or PP had HFA and WFH were similar to their counterparts. The mean HFA z-score of children with ES was less than 0 (p < 0.05) and the mean WFH z-scores of children with ES, NB, RF, or PP were less than 0 (p < 0.05). According to the study results, related growth outcome differed depending on constructs of picky eating behaviors. In particular, picky eating of ES showed a risk of faltering height growth in preschool children. Further comprehensive studies on the reason for ES and intervention approach is warranted.
Child ; Child, Preschool* ; Eating* ; Feeding Behavior* ; Humans ; Parents ; Prevalence ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to investigate the relationship between nurse managers' facilitative communication as perceived by nurses and nurses' self-esteem. METHODS: The subjects were 256 staff nurses at B hospital of C University in Kyeonggi-do. The data were collected between December 1, 2009 and January 12, 2010. The collected data were analyzed using the SAS program through t-test, ANOVA, Scheffe test, Pearson's correlation coefficients. RESULTS: Nurses' self-esteem was higher when nurse managers perceived them as facilitative communicators in empathic understanding and genuineness subgroup of facilitative communication (p<.05). There was a positive correlation between nurse managers' facilitative communication and nurses' self-esteem(r=.15, p=.015). Also there was a positive correlation among the nurse managers' facilitative communication subgroups, empathic understanding; genuineness; concreteness(r=0.18, p=.004; r=0.18, p=.003; r=0.19, p=.002) and nurses' self-esteem. CONCLUSION: Nurse managers are in need of facilitative communication. Therefore, job education and training for improving nurse managers' communication skills particularly related to empathic understanding, genuineness and concreteness are required.
Humans ; Nurse Administrators ; Phenothiazines