No abstract available.
Alcoholism* ; Primary Health Care*

The purpose of this study is to demonstrate a new postoperative analgesic which minimize the physiological changes of patients. Recently, it has become popular to administer opioids to epidural space rather than intravenously or by intramuscular administration. However, the side effects of opioids have limited the usefulness of this procedure. We tried to find out a way of providing postoperative analgesia while minimizing the side effects of opioids. This study has tested the effects of administering a mixture of small doses of morphine, fentanyl and bupivacaine and epidural morphine alone. The data of this study has taken from 20 paturients who have scheduled for cesarean section. We have classified into two groups which consist of 10 paturients each. We have administered epidural morphine alone to the first group and a small doses of morphine-fentanyl-bupivacaine mixture to second group. We have evaluated analgesic effects by comparing both groups' pain scores of the operative day and of the first postoperative day and evaluated such side effects as the degree of itching, nausea, vomiting, dizziness and respiratory depression by asking to paturients. This study has found the followings: 1) Pain scores of the first group in the operative day and the first postoperative day are 1.2+/-0.4 and 0.4+/-0.5. The second group's pain scores are 0.2+/-0.4 and 0, and the second group's pain scores have significantly reduced (p<0.05). 2) Frequencies of such side effects as itching, nausea and vomiting are higher in the first group (8) than in the second group(4). In conclusion, small doses of morphine-fentanyl-bupivacaine mixture has demonstrated a more effective postoperative analgesia with minimum side effects in pain controlling after cesarean section than epidural morphine alone.
Analgesia* ; Analgesics, Opioid ; Bupivacaine ; Cesarean Section* ; Dizziness ; Epidural Space ; Female ; Fentanyl ; Humans ; Morphine* ; Nausea ; Pregnancy ; Pruritus ; Respiratory Insufficiency ; Vomiting

T cell lymphoblastic lymphoma is characterized by immature lymphoid cells that are indistinguishable from the lymphoblasts and prolymphocytes of acute lymphoblastic leukemia. Several characteristic clinical features of lymphoblastic lymphoma, with include a high male-to-female ratio, a relatively high incidence in older children and young adults, the frequent presence of mediastinal involvement at the time of diagnosis. Also, this disease is rapidly progressive, and early dissemination to the bone marrow, blood, and central nervous system leads to the evolution of a picture resembling a acute lymphoblastic leukemia. We have experienced a rare case of congenital T-cell lymphoblastic lymphoma in which 1/365 year old female newborn had generalized multiple irregular protruding mass on her body. On bone marrow biopsy, CSF analysis, ultrasonogram and whole body MRI studies. We found metastasized tumor mass to, orbit, abdominal cavity, bulva, skin, and lower extremities. Histopathologically, specimen from mass on the right thigh showed diffuse infiltration of poorly differentiated and immature lymphoid cells in the skelectal muscle and subcutaneous soft tissue. By immunophenotyping studies using anti T cell and B cell monoclonal antibody, these cells were reactive with UCHL-1, MB2, but unreactive with MB1, L26. Based on these findings, the lesion was diagnosed as lymphoblastic lymphoma of the T-cell type, which occurred congenitally. Most T cell lymphoblastic lymphoma are noted, but congenital case was not reported. So we report it with a brief review of literature.
Abdominal Cavity ; Biopsy ; Bone Marrow ; Central Nervous System ; Child ; Diagnosis ; Female ; Humans ; Immunophenotyping ; Incidence ; Infant, Newborn ; Lower Extremity ; Lymphocytes ; Magnetic Resonance Imaging ; Orbit ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Skin ; T-Lymphocytes ; Thigh ; Ultrasonography ; Young Adult

PURPOSE: This study aimed to examine the effects of subjective memory complaints, depression and cognitive function on performance of activities of daily living (ADL) in individuals with mild cognitive impairment (MCI). METHODS: A total sample consisted of 250 MCI patients diagnosed within one year. All participants were assessed with a battery of standardized neuropsychological tests, self-report measures of subjective memory complaints and depression, and performance of basic and instrumental ADL. Correlational and multiple linear regression analyses were conducted to identify the factors associated with performance of basic and instrumental ADL, respectively. RESULTS: Executive function and depression explained 9.4% of the variance in basic ADL. Reduced executive function and greater depressed mood were associated with worse performance on basic ADL. Executive function, subjective memory complaints, and time since onset of cognitive symptoms accounted for 22.2% of the variance in instrumental ADL in individuals with MCI. Lower executive function (t=−2.02, p=.044), greater memory complaints (t=5.36, p<.001), and longer periods of experiencing cognitive symptoms (t=2.24, p=.026) were associated with worse instrumental ADL performance. CONCLUSION: These results may help healthcare professionals develop interventions to improve cognitive outcomes with better understanding of the relationship among cognition, mood, and behavioral performance in individuals with MCI.
Activities of Daily Living ; Cognition ; Delivery of Health Care ; Depression ; Executive Function ; Humans ; Linear Models ; Memory Disorders ; Memory ; Mild Cognitive Impairment ; Neurobehavioral Manifestations ; Neuropsychological Tests

BACKGROUND: Pelviscopic techniques have rapidly increased in therapeutic procedures as well as diagnostic procedures because of the many benefits associated with much smaller incisions than traditional open techniques. But the deliberate pneumoperitoneum with carbon dioxide during pelviscopic surgery may cause some problems-hypercarbia, pneumomentum, subcutaneous or mediastinal emphysema, pneumothorax, hypoxemia, hypotension, cardiovascular collapse and cardiac dysrhythmia. METHOD: We observed the changes of blood pressure (systolic, mean, diastolic), pulse rate, PaCO2, PaO2, peak inspiratory airway pressure and expired tidal volume at 10 minute after induction of general anesthesia (control value), 30 minutes and 60 minutes after insufflation of CO2 and Trendelenburg position. RESULTS: The blood pressure, PaCO2 and peak inspiratory airway pressure were increased significantly than control values (p<0.05). The changes of pulse rate and expired tidal volume were not statistically significant in comparison to control values. The PaO2 was decreased significantly (p<0.05). CONCLUSION: To minimize the risk of CO2 retension and unstability of cardiovascular system during pelviscopy under the Trendelenburg position, we must monitor the vital signs and the arterial blood gas status continuously and carefully.
Anesthesia, General* ; Anoxia ; Arrhythmias, Cardiac ; Blood Pressure ; Carbon Dioxide ; Cardiovascular System ; Head-Down Tilt* ; Heart Rate ; Hypotension ; Insufflation* ; Mediastinal Emphysema ; Pneumoperitoneum ; Pneumothorax ; Tidal Volume ; Vital Signs

BACKGROUND: Cine MR imaging has been found to bo a non-invasive technique in evaluation cardiac anatomy and cardiovascular function in a variety of cardiac diseases. The capability of this technique for quantatively estimating the severity of regurgitation has not been tested in newborns. The purpose of this study is to compare the degees of tricuspid regurgitation by echorcardiography with those by cine MRI, and verify the utility of MRi in evaluating tricuspid regurgitation. METHODS: Fifty-one newborns with tricuspid regurgitation were evaluated on the same day by echocardiography and cine MRI. Area and regurgitant fraction of area were estimated at four chamber view by two techniques. RESULTS: The area of tricuspid regurgitation was similar by two techniques. The correlation for the area(r=0.66, p<0.025) and the regurgitant area fraction(r=0.647, p<0.025) of tricuspid regurgitation obained by cine MRI with echocardiographic data was good. CONCLUSION: Cine MR imaging can provide quantative data estimating for evaluation of tricuspid regurgitation in newborns.
Echocardiography ; Echocardiography, Doppler* ; Heart Diseases ; Humans ; Infant, Newborn* ; Magnetic Resonance Imaging ; Magnetic Resonance Imaging, Cine* ; Tricuspid Valve Insufficiency*

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major cause of nosocomial infection and a molecular typing is necessary for proper epidemiologic investigations of sources and moles of spread in an outbreak. An nosocomial outbreak of MRSA in a neonatal intensive care unit at Ewha Womans University Mokdong Hospital was suspected. To investigate the clonality of isolates and control the spread of nosocomial outbreak, we performed plasmid restriction analysis of MRSA isolates from patients and medical staffs. METHODS: We studied 7 MRSA strains (umbilicus 4, blood 1, urine 1 and pus 1) from patients in a neonatal intensive care unit and the MRSA strains from nares and hands surveillance cultures of 26 medical staffs (4 medical doctors and 22 nurses). All MRSA strains were tested for antimicrobial susceptibility and plasmic analysis after EcoRI restriction. We analyzed the plasmid patterns of MRSA isolated from patients and compared with those from medical staffs. RESULTS: Ten MRSA strains (from 7 nares and 3 hands) were isolated from surveillance cultures of 26 medical staffs. Seven out of 10 MRSA strains from medical staffs revealed identical pattern of antibiogram which was the same pattern in all 7 MRSA strains from seven patients. Plasmid restriction patterns were classified 6 groups from A to F showing 2-10 bands. Six out of 7 MRSA strains from the patients showed group A(A1 5, A31) and 5 out of 10 MRSA strains from the medical staffs showed group A(A1 1, A21, A32, A41) and remainders showed different plasmid restriction analysis patterns. CONCLUSIONS: These results suggest that plasmid restriction analysis is a rapid, inexpensive, and good discriminating molecular typing of MRSA outbreak and is useful for the epidemiologic investigation of MRSA outbreaks in the clinical laboratory.
Cross Infection ; Disease Outbreaks ; Female ; Hand ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Staff ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Microbial Sensitivity Tests ; Molecular Epidemiology* ; Molecular Typing ; Plasmids* ; Suppuration

Midtrimester genetic amniocentesis has been a gold standard for prenatal diagnosis in antenatal care since last 25 years. After the triple serum marker test was introduced as a prenatal screening method for Down syndrome, the frequency of genetic amniocentesis was increased. OBJECTIVE: To determine the complication, risk of amniocentesis and detection rate of chromosomal abnormality. MATERIAL AND METHODS: A retrospective clinical analysis of 1,064 midtrimester genetic amnicentesis in IL Sin Christian Hospital antenatal clinic from Jan 1995 to Dec 1997. Chi square test was used for the statistical analysis and p value < 0.05 was considered significant. RESULTS: Amnicentesis were significantly increased in the age of 35-39 yrs and 40yrs over. And also the incidence of chromosomal abnormality was higher than younger age group. The indications of amnicentesis were screen positive of triple marker test(43%), advanced maternal age(20.8%), abnormal beta-hCG level, past history of chromosome abnormality or malformed baby and abnormal alpha-FP level in order. Total number of chromosomal abnormalities was 30 and the incidence of chromosomal abnormalities was 2.8%(30/1,064). The complications were developed in 13 cases and fetal loss rate was 0.78%(9/1,064). CONCLUSION: The detection rate of chromosomal abnormality in midtrimester amnicentesis for prenatal diagnosis was high and relatively safe procedure but, we should be attention to more careful manipulation.
Amniocentesis ; Biomarkers ; Chromosome Aberrations ; Down Syndrome ; Female ; Humans ; Incidence ; Pregnancy ; Pregnancy Trimester, Second* ; Prenatal Diagnosis ; Retrospective Studies

PURPOSE: The aim of this study was to examine the validity and reliability of the Korean Version of the Spiritual Care Competence Scale (K-SCCS). METHODS: A cross-sectional study design was used. The K-SCCS consisted of 26 questions to measure spiritual care competence of nurses. Participants, 228 nurses who had more than 3 years'experience as a nurse, completed the survey. Confirmatory factor analysis was used to examine the construct validity and correlations of K-SCCS and spiritual well-being (SWB) were used to examine the criterion validity of K-SCCS. Cronbach's alpha was used to test internal consistency. RESULTS: The construct and the criterion-related validity of K-SCCS were supported as measures of spiritual care competence. Cronbach's alpha was .95. Factor loadings of the 26 questions ranged from .60 to .96. Construct validity of K-SCCS was verified by confirmatory factor analysis (RMSEA=.08, CFI=.90, NFI=.85). Criterion validity compared to the SWB showed significant correlation (r=.44, p<.001). CONCLUSION: The findings suggest that K-SCCS serves as an appropriate measure of spiritual care competence with validity and reliability. However, further study is needed to retest the verification of the factor analysis related to factor 2 (professionalisation and improving the quality of spiritual care) and factor 3 (personal support and patient counseling). Therefore, we recommend using the total score without distinguishing subscales.
Cross-Sectional Studies ; Humans ; Mental Competency* ; Reproducibility of Results* ; Spirituality

Over the past 30 years, there has been an increase in the incidence of multifetal pregna-ncies, primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses, primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore, selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper, we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet, 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9~10 weeks of gestation. After the prcedure, 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation, 2 patients were at 35 weeks, and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.
Fetus ; Humans ; Incidence ; Infertility ; Ovulation Induction ; Parturition ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Twin ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted ; Triplets ; Twins