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

The anterior decompression and anterior interbody fusion have been the choice of surgical treatment for spinal tuberculosis since 1960. But, multi-level spinal tuberculosis involved more than three vertebrae resulted in large post-debridement defect and spinal instability. So, failure of the graft was very common & postoperative maintenance of the kyphotic angle correction was very difficult. In part of such cases as multi-level spinal tuberculosis, we performed supplementary anterior instrumentation in a single-stage procedure. The authors analyzed total 39 surgical cases of multi-level tuberculosis of the thoracolumbar spine from January 1985 to June 1992. The patients treated only with a strut graft were designated as group I(n=23) and the patients added by anterior instrumentation as group II(n=16). Mean age of 39 cases was 33.1 years, and mean follow-up period was 31.6 months. The purpose of this study was to compare the postoperative results of group I with those of group II by measuring the angular kyphosis on serial lateral roentgenograms, and to provide an aid in selecting method of surgery before treatment of multi-level spinal tuberculosis with high risk of progression of kyphosis. The results were as follows: 1. There were 16 cases of thoracolumbar, 14 cases of thoracic, 9 cases of lower lumbar lesions, and numbers of vertebrae involved were 4.2 in mean. 2. By standard Cobb lateral measurement, mean preoperative angle of segmental kyphosis was 32.5° in group I, and 45.1° in group II, and group II proved as more kyphotic. After operation, mean angle of segmental kyphosis was 24.7° in group I and 32.4° in group II. 3. On final F/U, mean angle of segmental kyphos was 32.7° in group I, and 37.3° in group II, and final loss of correction was 8.0° in group I, 4.9° in group II. 4. There were 8 patients(34.8%) of graft-related complications in Group I, and 2(12.5%) in group II. And graft failure in group I resulted in severe loss of correction of segmental kyphosis, but graft failure in group II did not, through graft protection by anterior instrumentation. 5. There were 3 patients(18.8%) of implant-related problems in group II; two during and one after union. In these former two cases, bony union was obtained without loss of correction by prolonged application of brace. No cases of group II was associated with persistence or recurrence of infection after instrumentation. In our opinion, anterior interbody fusion and combined anterior instrumentation can be effective and safe one of methods in surgical treatment for multi-level tuberculosis of the spine which has been considered as the most important determinant of the result by its extensive vertebral involvement with resulting large post-debridement defect to be struted.
Braces ; Decompression ; Follow-Up Studies ; Humans ; Kyphosis ; Methods ; Recurrence ; Spine ; Transplants ; Tuberculosis ; Tuberculosis, Spinal

Vertebral stabilization using transpedicular screw fixation device is widely used in the surgical treatment of degenerative lumber diseases such as spinal stenosis, pseudospondylolisthesis, and spinal instability. The use of transpedicular screw fixation devices provides substantial advantages with regard to an increase of the rate of solid arthrodesis, early rehabilitation, short segment spinal fusion, and restoration of sagittal lumbar lordosis. The authors analyzed 11 patients showing definite postoperative loss of the lumbar sagittal lordosis in a total of 110 surgical cases of degenerative lumbar diseases who underwent segmental spinal fusion using transpedicular screws from January 1981 to December 1993. The purpose of this study was to analyze the causes of loss of lumbar sagittal lordosis in the instrumented segments and to present some precautions in transpedicular screw fixation for surgical patients with degenerative lumbar spines to maintain corrected lumbar sagittal lordosis. The results from this study were as follows: 1. By standard Cobb lateral measurements, eleven cases in a total of 110 patients showed definite loss of lumbar sagittal lordosis more than 4 degrees. 2. The period reflecting loss of lordosis was roughly within postoperative four months which were critical fusion time of the grafted bone mass, which lasted an average of 4.8 months in this study. 3. The implants led to loss of lordosis consisted of 6 cases in 53 Diapasons, 4 cases in 32 Wiltses, and a case in 15 Steffee plate systems. Diapason & Steffee plate systems were classified as a rigid type and Wiltse system as a flexible one. 4. The causes of postoperative loss of lordosis were recognized as 2 cases of screw toggling, 5 cases of screw-rod locking failure and 4 cases of rod bending. 5. The group resulted in more loss of lordosis in degrees was related to significant change between preoperative and postoperative lordosis, distraction of disc space during operation, extensive discectomy, and reduction of degenerative spondylolisthesis which were the cases of the anterior column deficiency.
Animals ; Arthrodesis ; Diskectomy ; Humans ; Lordosis ; Rehabilitation ; Spinal Fusion ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Transplants

PURPOSE: This study was performed to find the clinical significance in protein C as a differential marker in the beginning stage of infection and prognosis factor in severe infection among pediatric patients who were admitted due to fever. METHODS: A total of 40 pediatric patients who had temperatures higher than 37.5degrees C on admission at the Department of Pediatrics, Chungnam National University between December, 2002 and August, 2003 were enrolled. Total white blood cell count(WBC), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP) and protein C were performed for those patients on admission. Clinical progress, diagnosis and prognosis were reviewed for these patients. The 40 patients were divided into two groups based on the diagnosis of bacterial and nonbacterial infections. RESULTS: Twenty patients(50%) were suspected of bacterial infections that showed positive results in blood, sputum, urine, and spinal cord fluid. There were eight cases with bacterial pneumonia, five with urinary tract infection, four with bacterial meningitis, two with cellulitis, and one with typhoid fever. The remaining 20 patients were diagnosed with nonbacterial infections because they had negative results in blood cultures. ESR and CRP were increased beyond normal range in both groups. However, protein C was significantly decreased in the bacterial infection group and yet normal range in the nonbacterial infection group(P<0.05). CONCLUSION: Protein C can be used as a differential marker in order to distinguish between bacterial and nonbacterial infections. In addition, protein C can possibly be used as a prognostic factor that can predict severe infection.
Bacterial Infections* ; Blood Sedimentation ; Cellulitis ; Chungcheongnam-do ; Diagnosis ; Fever* ; Humans ; Leukocytes ; Meningitis, Bacterial ; Pediatrics ; Pneumonia, Bacterial ; Prognosis ; Protein C* ; Reference Values ; Spinal Cord ; Sputum ; Typhoid Fever ; Urinary Tract Infections

PURPOSE: This research was conducted to explore the experiences of graduate student women with children fulfilling multiple roles and to generate a substantive theory. METHODS: This study uses the grounded theory method based on Strauss and Corbin(1988)'s method. Interviews were conducted with 11 graduate student women who had children aged three of older. RESULTS: The core category of this research is 'Role balancing for self-generativity'. Based on the core category, three types of married women graduate students' experiences were found. They are 'concentrating on graduate-work' 'postponing graduate-work' and 'adjustment between two roles' CONCLUSIONS: Through understanding the married women's multiple roles experience process, there can be a basis for making a women's health system and social support system for the married women graduate student. Also, this research is to generate a substantive theory which can helps to change social perspectives on the quality of life for the women who will contribute in Korean society as professionals.
Aged ; Child ; Female ; Humans ; Quality of Life ; Women's Health

PURPOSE: Periventricular leukomalacia(PVL) is the most important cause of cerebral palsy in premature infants. However, there are relatively few studies demonstrating the correlation between ultrasound findings and neurologic outcomes of low-birth-weight infants. To clarify the situation, we analyzed ultrasound findings and neurologic outcomes of many infants with periventricular leukomalacia. METHODS: Our study includes 36 infants with PVL, born in Chungnam National University Hospital, from October 1998 to December 2001. 25 infants with bilateral PVL were compared with 11 infants with asymmetric PVL. For a period of 12 to 48 months, the children were evaluated with neurologic assessments. RESULTS: In infants with bilateral lesions, 88%(22/25) of them had evidence of cerebral palsy. 16 children had spastic quadriplegia and others had spastic diplegia. 7 children with unilateral lesions were free of motor sequele at follow up. Other neurologic handicaps(mental retardation, opthalmologic abnormality or epilepsy) were not related with the symmetry or sizes of the lesions. CONCLUSION: In this study, unfavorable neurologic outcomes of bilateral PVL are confirmed. Therefore, every effort should be made to prevent the development of periventricular leukomalacia as well as not to miss the diagnosis. In addition, if there are any small lesions, regular neurologic assessments and early start of rehabilitation programs should be done.
Cerebral Palsy ; Child ; Chungcheongnam-do ; Diagnosis ; Follow-Up Studies ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Leukomalacia, Periventricular* ; Quadriplegia ; Rehabilitation ; Ultrasonography

BACKGROUND: Healthy cities of Korea have engaged in various activities regarding the Korea Healthy Cities Partnership, and research activities on healthy cities is one of the important area. In the present context, due to the current policy to pursue Sustainable Development Goals locally and globally, it is essential to emphasize the importance of healthy city. Therefore, it is important to identify the research trend related to healthy city. The aim of this study was to find out research trend of healthy city studies from 1990 to 2014 by reviewing published papers and studies systematically. Based on the finding of the study, the necessary implications on future research directions of the healthy city are obtained. METHODS: The area of this study is domestic journal (Korea), international journal, thesis, and research report focusing on healthy city from 1990 to 2014. The selection of data was performed using keyword is based on domestic and international database. The analysis criteria were divided into year of publication, type of study, subjects, study methods, and study area. RESULTS: One hundred twenty papers were selected for the analysis. Papers related to the healthy city issue were published 4.8 times in an average in a year during that the period. However, the number of papers published increased dramatically in the recent 4 years. Of total, 28 papers (44.4%) focused on the healthy city policy and urban environmental improvement, 18 papers (28.6%) focused on health promotion, and the remaining were program centered. Most papers (71 out of 120) used quantitative study methods. Of total studies, studies have conducted in Jinju city (9), Wonju city (8), Changwon city (6) and Gangnam-gu (5), respectively, as a study area of healthy city. CONCLUSION: First, domestic healthy city researches has been gradually increasing every year, over the past 10 years which has heightened interest in healthy cities. Second, the expansion of the various areas of research is required in order to contribute to future sustainable healthy city. Third, in recent years, by taking advantage of a variety of research methods, conducting the qualitative and mixed method research is considered to be a desirable change.
Gangwon-do ; Gyeongsangnam-do ; Health Promotion ; Korea* ; Natural Resources ; Publications ; Research Report

PURPOSE: This was a methodological research to develop an instrument to assess the emotional response of family members of physically restrained patients. METHODS: A primary instrument with 68 questions was developed based on literature review and semi-structured interviews with family members. A group of experts revised individual questions and removed 4 irrelevant questions. This secondary instrument, then, was tested with 199 family members of physically restrained patients in intensive care units of a university hospital. The validity and reliability of the instrument were tested by factor analysis. RESULTS: After item analysis, 3 questions with a correlation coefficient under .30 were discarded and the questions with a factor loading under .45 on Varimax Rotation were also removed. After factor analysis on the final 37 questions, 7 factors were identified; avoidance, shock, helplessness, grudge, depression, anxiousness, and acceptance. The total variance explained was 55.63%. The reliability of this instrument was 0.93 of Cronbach's alpha. CONCLUSION: This instrument was statistically reliable and valid to measure family's emotional response to physical restraints of the patients. This instrument can be useful in assessing the effects of nursing interventions for family members of restrained patients.
Adolescent ; Adult ; Child ; Emotions ; Family/*psychology ; Female ; Humans ; Intensive Care Units ; Interviews as Topic ; Male ; Middle Aged ; *Program Development ; Questionnaires ; Reproducibility of Results ; *Restraint, Physical

BACKGROUND: The stress of operation inhibits bowel motility. The blockade of efferent sympathetic nerve is helpful to recovery of bowel motility. So we tried to examine that the extent of sympathetic blockade by alterations of bupivacaine infusion rate affected the recovery of bowel motility. METHODS: Group 1 (N = 25) received postoperative meperidine intramuscular injection on demand as a control group, group 2 (N = 25) received postoperative epidural 0.125% bupivacaine 100 ml plus morphine 10mg by infusion pump, 1 ml/hour, for 4days, group 3 (N = 25) received 0.125% bupivacaine 400 ml plus morphine 10mg by infusion pump, 4 ml/hour, for 4days. The Group 2 and 3 received additional morphine 2mg in 0.2% bupivacaine 10 ml epidurally as a single bolus when the peritoneum was closed. The time interval from termination of operation to the first passage of flatus was estimated. RESULTS: In group 1, bowel motility was regained at 92+/-23 hours, group 2 ; 90+/-19 hours and group 3 ; 91+/-19 hours. All values are not significantly different among the groups (p>0.05). CONCLUSIONS: The alteration of epidural bupivacaine and morphine infusion rate did not affect the recovery of postoperative bowel motility.
Anesthetics ; Bupivacaine* ; Flatulence ; Infusion Pumps ; Injections, Intramuscular ; Meperidine ; Morphine* ; Peritoneum

BACKGROUND: Antibiotic resistance of group A streptococci (GAS) is increasing nationwide. Pulsed-field gel electrophoresis (PFGE) is useful for investigating genetic relationship among outbreaks of bacterial infection. Erythromycin (EM) resistance is mediated by either ermB, ermTR, or mefA gene.The emm gene encodes M protein which is the most important virulence factor of GAS. METHODS: The clonal relationship among 56 EM resistant GAS isolated from the children with acute pharyngitis in Jinju was investigated by analysis of chromosomal DNA restriction pattern with SmaI enzyme. The ermB and mefA genes were amplified and emm genotype was identified with PCR and sequencing. Their relationship with PFGE pattern was investigated. RESULTS: The emm genotyes were identified as 2, 3, 12, 18, and 75. Mostly emm12 had ermB gene, while emm 3, 18 and 75 had mefA resistance gene. All strains with mefA gene were not restricted with SmaI. The emm12 strains showed 5 different PFGE patterns. CONCLUSIONS: The emm genotypes were closely related with resistance genes. Analysis of macrorestriction fragment patterns by PFGE showed that EM resistant GAS were polyclonal at least in Jinju. GAS strains with mefA gene were not restricted with SmaI suggesting mefA gene might inhibit chromosomal digestion with SmaI.
Bacterial Infections ; Child ; Digestion ; Disease Outbreaks ; DNA ; Drug Resistance, Microbial ; Electrophoresis, Gel, Pulsed-Field* ; Erythromycin* ; Genotype ; Gyeongsangnam-do ; Humans ; Pharyngitis ; Polymerase Chain Reaction ; Virulence