Hyponatremia is frequently seen in intracranial hemorrhagic patients and has been often attributed to inappropriate secretion of antidiuretic hormone. But in recent years, a number of studies have shown that hyponatremia in many patients with intracranial disease may actually be caused by cerebral salt wasting (CSW) syndrome and circulating Atrial natriuretic peptide (ANP) and Brain natriuretic peptide (BNP) are probably involved. This report describes a patient who developed bacterial meningites caused by pseudomonas aeruginosa and CSW syndrome after removal of pituitary adenoma. CSW syndrome resolved by fluid and salt replacement after 4 months.
Humans ; Hyponatremia ; Meningitis* ; Meningitis, Bacterial ; Natriuretic Peptide, Brain ; Pituitary Neoplasms* ; Pseudomonas aeruginosa ; Pseudomonas* ; Wasting Syndrome*

OBJECTIVE: To compare physiological cost index of the two manual wheel chair propulsion methods: pushing the handrim forward and reversely, and to find out whether the reverse propulsion method will help prevention of the carpal tunnel syndrome in manual wheelchair users. METHOD: The subjects were thirty healthy men in their twenties. All of them performed two manual wheelchair propulsion methods for two days, foreward propulsion on the first day and reverse propulsion the next day. Duration of the wheelchair propulsion was ten minutes. Electromyography (EMG) of wrist extensor groups, biceps brachii, pectoralis major, trapezius, and triceps brachii, and heart rates were recorded. The EMG activity of each individual was transformed to root mean square (RMS), EMG activity appearance time (%), and EMG activity continuance time (%). RESULTS: EMG activity of the wrist extensors in reverse propulsion of the wheelchair was less active compared to forward propulsion. In reverse propulsion method, energy efficiency was not significantly increased, but RMS of wrist extensor groups was significantly reduced. Contractions of trapezius and biceps brachii muscles appeared in earlier phase of propulsion. CONCLUSION: We concluded that reverse propulsion of the wheelchair will be more effective method of wheelchair propulsion compared to forward propulsion in preventing carpal tunnel syndrome in long-term wheelchair users. The reverse propulsion method in this study uses wrist extensor less, which can reduce the wrist extension movement during wheelchair propulsion. It can possibly contribute on the prevention of carpal tunnel syndrome in long-term wheelchair users.
Carpal Tunnel Syndrome ; Electromyography ; Heart Rate ; Humans ; Male ; Muscles ; Superficial Back Muscles ; Upper Extremity* ; Wheelchairs* ; Wrist

Tumoral calcinosis (TC) is a condition resulting from extensive calcium phosphate precipitation, primarily in the periarticular tissues around major joints. Calciphylaxis is a fatal ischemic vasculopathy mainly affecting dermal blood vessels and subcutaneous fat. This syndrome is rare and predominantly occurs in patients with end-stage renal disease. Here, we report on a rare case involving a patient with TC complicated with calciphylaxis. Our patient was a 31-year-old man undergoing hemodialysis who presented with masses on both shoulders and necrotic cutaneous ulcers, which were associated with secondary hyperparathyroidism, on his lower legs. He underwent subtotal parathyroidectomy, and sodium thiosulfate (STS) was administered for 27 weeks. Twenty months after beginning the STS treatment course, he experienced dramatic relief of his TC and calciphylaxis.
Adult ; Blood Vessels ; Calcinosis* ; Calciphylaxis* ; Calcium ; Humans ; Hyperparathyroidism, Secondary ; Joints ; Kidney Failure, Chronic ; Leg ; Parathyroidectomy* ; Renal Dialysis ; Shoulder ; Sodium* ; Subcutaneous Fat ; Ulcer

PURPOSE: The purpose of the study was to describe the experiences of do-not-resuscitate (DNR) among nurses. METHODS: Data were collected by in-depth interviews with 8 nurses in 8 different hospitals. Conventional qualitative content analysis was used to analyze the data. RESULTS: Eight major themes emerged from the analysis: DNR decision-making bypassing the patient, inefficiency in the decision-making process of DNR, negative connotation of DNR, predominance of verbal DNR over written DNR, doubts and confusion about DNR, least amount of intervention in the decision for DNR change of focus in the care of the patient after a DNR order, and care burden of patients with DNR. Decision-making of DNR occurred between physicians and family members, not the patients themselves. Often high medical expenses were involved in choosing DNR, thus if choosing DNR it was implied the family members and health professionals as well did not try their best to help the patient. Verbal DNR permission was more popular in clinical settings. Most nurses felt guilty and depressed about the dying/death of patients with DNR. CONCLUSION: Clearer guidelines on DNR, which reflect a family-oriented culture, need to be established to reduce confusion and to promote involvement in the decision-making process of DNR among nurses.
Adult ; Attitude to Death ; Critical Care ; Decision Making ; Family/psychology ; Humans ; Interviews as Topic ; Korea ; Nursing Staff, Hospital/*psychology ; Professional-Family Relations ; *Resuscitation Orders/psychology ; Social Support ; Tape Recording

An exercise-induced idiopathic Brugada electrocardiographic pattern during the effort phase is very rare. A 42-year-old male visited our cardiology clinic for chest discomfort. He has been treated for myocardial infarction 2 months ago. He underwent a treadmill test according to the Bruce protocol. Typical coved-type ST-segment elevation was found during the effort phase, and it gradually recovered after the exercise. The ST-segment elevation appeared to be unrelated to hypervagotonia. This elevation was not induced by a pharmacological test with flecainide. A significant ventricular arrhythmia was not induced by programmed ventricular stimulation. Hence, we discharged the patient without implantation of an implantable cardioverter defibrillator.
Adult ; Arrhythmias, Cardiac ; Cardiology ; Defibrillators ; Electrocardiography* ; Exercise Test ; Flecainide ; Humans ; Male ; Myocardial Infarction ; Thorax ; Vagus Nerve

OBJECTIVE: To investigate the group differences in contents of subjective memory problem and objective cognitive functions in late life depression and mild cognitive impairment. METHODS: 40 participants were classified into three groups [normal, amnestic mild cognitive impairment (MCI), and depression]. Differences in subjective memory complaints were examined using the Prospective and Retrospective Memory Questionnaire. And the Consortium to Establish a Registry for Alzheimer's Disease-Korean version neuropsychological assessment battery results were used for evaluating objective cognitive functions. Group differences were analyzed ANCOVA analysis. RESULTS: In post-hoc analysis, the questions "Do you fail to recognize a character in a radio or television show from scene to scene?" and "Do you forget something that you told a few minute before?" were significantly able to discriminate between the MCI and normal groups. In post-hoc analysis, late life depression group showed significantly higher score on the question "Do you intend to take something with you, before leaving a room or going out, but minutes later leave it behind, even though it's there in front of you?". CONCLUSION: The result demonstrates the presence of differences in the contents of subjective memory complaints according to groups. Subjectively reported memory complaints in MCI group are related to deficits in learning new information. In late life depression, memory complaints are more related to difficulty in executive functions.
Depression* ; Executive Function ; Learning ; Memory* ; Mild Cognitive Impairment* ; Neuropsychological Tests ; Prospective Studies ; Surveys and Questionnaires ; Retrospective Studies ; Self Report ; Television

No abstract available.
Brain ; Brain Neoplasms ; Cerebral Infarction ; Infarction, Middle Cerebral Artery ; Middle Cerebral Artery ; Vasospasm, Intracranial

PURPOSE: To suggest a surgical normogram for lateral rectus recession in exotropia associated with unilateral or bilateral superior oblique muscle palsy (SOP). METHODS: We retrospectively reviewed the charts of 71 patients with exotropia who were successfully corrected over one year. Each patient had undergone unilateral or bilateral rectus recession associated with uni- or bilateral inferior oblique (IO) 14 mm recession, using a modified surgical normogram for lateral rectus (LR) recession, which resulted in 1 to 2 mm of reduction of LR recession. We divided all patients into 2 groups, the 34 patients who had undergone LR recession with unilateral IO (UIO) recession group and the remaining 37 patients who had undergone LR recession with bilateral IO (BIO) recession group. Lateral incomitancy was defined when the exoangle was reduced by more than 20% compared to the primary gaze angle. The surgical effects (prism diopters [PD]/mm) of LR recession were compared between the two groups using the previous surgical normogram as a reference (Parks' normogram). RESULTS: The mean preoperative exodeviation was 20.4 PD in the UIO group and 26.4 PD in the BIO group. The recession amount of the lateral rectus muscle ranged from 4 to 8.5 mm in the UIO group and 5 to 9 mm in the BIO group. Lateral incomitancy was noted as 36.4% and 70.3% in both groups, respectively (p = 0.02). The effect of LR recession was 3.23 +/- 0.84 PD/mm in the UIO group and 2.98 +/- 0.62 PD/mm in the BIO group and there was no statistically significant difference between two the groups (p = 0.15). CONCLUSIONS: Reduction of the LR recession by about 1 to 2 mm was successful and safe to prevent overcorrection when using on IO weakening procedure, irrespective of the laterality of SOP.
Child ; Exotropia/complications/physiopathology/*surgery ; Eye Movements ; Female ; Follow-Up Studies ; Humans ; Male ; *Nomograms ; Oculomotor Muscles/physiopathology/*surgery ; Ophthalmologic Surgical Procedures/*methods ; Retrospective Studies ; Treatment Outcome ; Trochlear Nerve Diseases/*complications/physiopathology/surgery

PURPOSE: This study aimed to assess the discomfort and factors influencing the discomfort of cancer patients with peripherally inserted central catheters (PICC). METHODS: A cross-sectional survey was conducted at a tertiary university-based hospital in Seoul in 2013. Subjects were eligible if patients were diagnosed with cancer and four weeks had passed since the PICC was inserted. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS) and discomfort was assessed with 8 questions developed through qualitative interviews and a literature review. Questions were about pain, interruption of daily activity or leisure, satisfaction, usefulness and feelings towards the PICC. RESULTS: Total 111 patients participated in the study. Over 75% of patients reported annoyance with PICC line. There was low positive correlation between discomfort due to PICC and anxiety. In anxious patients, patients discomfort was significantly higher than that of non-anxious patients. Significant factors influencing discomfort were gender, age, education level, PICC complications and anxiety. CONCLUSION: Patient engagement in selecting the type of catheter and individualized care considering the level of anxiety and patient demographics might help to reduce discomfort in cancer patients.
Anxiety ; Catheters* ; Cross-Sectional Studies ; Demography ; Depression ; Education ; Humans ; Leisure Activities ; Patient Participation ; Seoul ; Vascular Access Devices

BACKGROUND: We investigated the causative agents of hemorrhagic diarrhea which occurred in newborn babies in a hospital nursery in July, 2002. Rotavirus was not confirmed as the cause because only a few patients were positive for rotavirus test while most others with hemorrhagic diarrhea were negative. Therefore, patients with bloody stool were tested for Salmonella, Shigella, rotavirus, adenovirus, enterovirus, astrovirus, and enterohemorrhagic Escherichia coli (EHEC). METHODS: Bloody stools from 12 newborns with hemorrhagic diarrhea were tested. Polymerase chain reaction (PCR) of shiga-toxin gene was performed for EHEC. Rotavirus and adenovirus were tested with latex agglutination kit (Orion Diagnostica). Reverse transcription (RT)-PCR was performed for enterovirus. To detect astrovirus, RNA was extracted with Viral RNA Mini Kit (QIAGEN), reverse-transcribed with random hexamer, and PCR-amplified with specific primers. RESULTS: Of the 12 patients tested, seven (58%) were positive for astrovirus RT-PCR while all were negative for Salmonella, Shigella, EHEC, rotavirus, adenovirus, and enterovirus. CONCLUSIONS: Although diarrhea caused by astrovirus is known to be milder than that caused by rotavirus, our cases showed that astrovirus could cause serious bloody diarrhea in newborn babies.
Adenoviridae ; Agglutination ; Cross Infection ; Diarrhea* ; Enterohemorrhagic Escherichia coli ; Enterovirus ; Humans ; Infant, Newborn* ; Latex ; Nurseries, Hospital ; Polymerase Chain Reaction ; Reverse Transcription ; RNA ; RNA, Viral ; Rotavirus ; Salmonella ; Shigella