PURPOSE: The staging of bladder carcinoma is a major determinant of operative management. CT of bladder carcinoma has been widely used to diagnose external extension (pT3b and over), but tumors confined to the bladder wall (from pT1 to pT3a) are poorly delineated. The authors describe CT findings of the superficial bladder carcinoma (below T1, stage A) in thin section CT with air insufflation technique (air insufflation-CT) to facilitate early detection and to aid correct staging of the superficial bladder carcinoma. MATERIALS AND METHODS: The materials consisted of proved 24 cases (1'9 patients, single tumor: 16 patients, multiple tumors :3 patients) of stage A bladder carcinomas. Air insufflation-CT was performed by the infusion of approximately 200 mL of air into the bladder via a Foley catheter. After the routine pelvic CT, bladder tumors were re-scanned with 1.5 to 5 mm thickness and intervals. RESULTS: The superficial bladder carcinomas were detected as nodular(5 cases, 20.8%), papillary(15 cases, 62.5%), pyramidal(2 cases, 8.3%), and domed(2 cases, 8.3%) forms on air insufflation CT. These tumors were classified into three types according to the size of the tumoral neck:type I(pedundulated polypold tumor:4 cases, 16.6%), type II(polypid tumor with short neck :13 cases, 54.2%), and type Ill(sessile tumor :7 cases, 29. 2%). The mean size(tumoral width x height x base o, neck/stalk) of the tumors was 22 x 20 x 16mm. The average tumoral sizes according to each type of the superficial tumors were type 1:22 x 25 x 6mm, type 11:23 x 22 x 18mm, and type III :18 x 15 x 18mm. The mean width of the type I--II tumoral necks was 15mm. The mean length of the type I tumoral neck(pedicle) was 2.5mm. Papillary fronds of the tumors were seen in 10 cases(41.7%) of 24 superficial tumors. Outer margin of the involved bladder wall was smooth in all cases. CONCLUSION: Thin-sectin CT with air insufflation technique for bladder carcinoma was useful in tumoral demonstration, and characteristics of the superficial bladder carcinomas were small polypold tumors had a short neck mostly and smooth outer wall of the involved bladder wall.
Catheters ; Humans ; Insufflation* ; Neck ; Urinary Bladder Neoplasms ; Urinary Bladder*

Purpose: The purpose of this study was to investigate the effects of emotional labor and communication competence on geriatric nursing in nurses-related stress in nurses caring for older patients. Methods: The sample consisted of 147 general hospital nurses. Data were analyzed through the SPSS/WIN 21.0 program using descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficients, and multiple regression. Results: The factors of emotional labor (β=.38, p<.001)and positive communication competence (β=-.20, p=.021) had the greatest influence on the level of stress related to geriatric nursing in nurses caring for older patients. The total explanatory power was 20.3%. Conclusion It was found that emotional labor and communication competence were influencing factors in the stress related to geriatric nursing. Therefore, to improve nurses’ stress related to geriatric nursing, strategies to manage the emotional labor, and to strengthen and develop positive communication competence need to be developed.

PURPOSE: The demand for suitable organs in the world greatly outweighs the supply of transplantable organs. Perceptions and attitudes of the attending physician to brain death are pivotal for the organ donation process in brain dead donors. The purpose of this study is to evaluate the perceptions and attitudes of the attending physician on brain death and organ donation in order to promote the organ donation from brain dead donors in Korea. METHODS: Questionnaires were collected from 194 (17.9%) among 1,018 physicians and were analyzed by descriptive statistics. RESULTS: 97.5% (189/194) of respondents have positive attitudes toward organ donation. Although 97.9% (190/194) have experienced donor management, the referral rate was no more than half (96/194, 49.5%). The main barriers against organ donation were lack of knowledge on organ donation and transplantation (60/129, 46.5%), cultural background (27/120, 20.9%) and complexity in the organ donation process (12/129, 9.3%). CONCLUSION: Promotion of organ procurement organization and well trained-education programs are crucial to help attending physicians to understand the organ donation process, and eventually to increase the rate of organ donations in brain dead donors.
Brain Death* ; Brain* ; Humans ; Korea ; Surveys and Questionnaires ; Referral and Consultation ; Surveys and Questionnaires ; Tissue and Organ Procurement* ; Tissue Donors* ; Transplantation

Simultaneous multiple coronary artery thrombosis is a rare finding in ST segment elevation myocardial infarction (STEMI). We report a case of myocardial infarction with multiple ST segment elevation on the electrocardiography and total occlusions of the distal left anterior descending artery (dLAD), as well as of the second and third obtuse marginal artery on emergency coronary angiography. Thrombus aspiration was performed at dLAD and systemic glycoprotein IIb/IIIa inhibitor was used successfully. In patients with STEMI, multiple coronary thromboses are unusual and associated with patient fatality. However, assertive thrombus aspiration and antiplatelet therapy could be effective in STEMI patients with multiple distal coronary artery occlusions.
Arteries ; Coronary Angiography ; Coronary Artery Disease ; Coronary Thrombosis ; Coronary Vessels ; Electrocardiography ; Emergencies ; Glycoproteins ; Humans ; Myocardial Infarction ; Thrombosis

BACKGROUND: Glomerular injury induced by angiotensin II (Ang II) may arise from its hemodynamic or non-hemodynamic actions including oxidative stress, or from such effects of Ang II acting in concert. The release of reactive oxygen species from podocytes may play a role in the pathogenesis of glomerular damage and proteinuria. METHODS: To investigate whether Ang II induces oxidative stress in vitro in glomerular epithelial cells (GEpC) and whether such oxidant stress may increase in vitro glomerular permeability model using cultured GEpC, we studied GEpC culture exposed to Ang II and antioxidant, probucol. For oxidative system assay, we measured the production of superoxide anion and hydrogen peroxide and the activity of superoxide dismutase (SOD). Scanning electron microscopy was performed on cells grown for one week on chamber slides. RESULTS: We found that in vitro permeability, which was prevented from probucol, increased significantly in media with 10-4 and 10-5 M of Ang II by 15.9% and 13%, respectively. Administration of the 10-5 M of Ang II significantly increased the superoxide anion productions by 39%, 61% and 30% at 1, 2 and 6 hours exposure time, respectively, compared to those of control and suppressed by probucol to control levels. At high concentration (10-5 M) Ang II suppressed the activity of SOD without affecting the production of hydrogen peroxide on the other hand, at low concentration (less than 10-5 M) Ang II showed reverse results. On ultrastructural examination, we could see the shortened and fused microvilli on GEpC surface by 10-5 M of Ang II, which change could be prevented by probucol. CONCLUSION: We could suggest that Ang II induces the generation of superoxide anion and the suppression of the activity of SOD, and subsequent oxidative stress leading to increase glomerular permeability by disruption of glomerular filtration barrier.
Angiotensin II* ; Angiotensins* ; Epithelial Cells* ; Glomerular Filtration Barrier ; Hand ; Hemodynamics ; Hydrogen Peroxide ; Microscopy, Electron, Scanning ; Microvilli ; Oxidative Stress* ; Permeability* ; Podocytes ; Probucol ; Proteinuria ; Reactive Oxygen Species ; Superoxide Dismutase ; Superoxides

PURPOSE: To evaluate the MR findings of gestational trophoblastic tumor(GTT) in correlation with pathological results. MATERIALS AND METHODS: Nine patients who confirmed the diagnosis (four choriocarcinomas and five invasive moles) constituted the basis of our study. Pathologic specimens were taken from the tumors corresponding to the regions of interest on MR images. The MR images were analyzed in respect of the morphology and signal intensity of the tumors, uterine and adnexal vascularity, and the adnexal lesion. RESULTS: The MR findings of four choriocarcinomas were well-defined, hemorrhagic masses with central necrosis;the masses were hyperintense on Tl-weighted images. In contrast, the five invasive moles showed irregular and permeative masses with densely enhanced solid components and tiny cystic lesions. The trophoblastic proliferation, coagulation necrosis, and molar villi had variable signal intensities on Tl-and T2-weighted images. CONCLUSION: Our results suggest that MR imaging is a promising tool for noninvasive morphologic analysis of GTTS.
Choriocarcinoma ; Diagnosis ; Female ; Humans ; Hydatidiform Mole, Invasive ; Magnetic Resonance Imaging* ; Molar ; Necrosis ; Pregnancy ; Trophoblastic Neoplasms* ; Trophoblasts*

OBJECTIVES: The rates, correlates, and factor structure of depressive symptoms in a Korean rural sample were examined using Korean version of the Center for Epidemiologic Studies Depression Scale(CES-D). METHODS: Door to door visiting survey was conducted by trained interviewers. A random cluster sample of 1,315 respondents, aged 30 and over completed the CES-D scale along with additional sociodemographic questionnaires. RESULTS: In this sample, mean CES-D score of male and female were 7.8 and 9.5, respectively, which were lower than those reported previously. Symptoms of depression were most common among the less educated, non-married and female according to ANCOVA. Age was not a significant risk factor for depressive symptoms. Different factor structures emerged from this sample as compared to other studies using this approach. Somatic symptoms and affective symptoms were combined as one factor and emotional hardship emerged as a separate factor. CONCLUSIONS: Symptom scores and risk factors were similar to the results reported in other countries but unique factor structures were found in this study. Further research is needed about the Korean depressive symptomatology and related areas.
Affective Symptoms ; Surveys and Questionnaires ; Depression* ; Epidemiologic Studies ; Epidemiology ; Female ; Humans ; Male ; Risk Factors*

PURPOSE: Early detection of arteriovenous fistula (AVF) dysfunction in hemodialysis patients and prompt corrective procedures reduces the AVF thrombosis rates and lengthens access survival. We tried to develop a new simple and cheap bedside measurement technique based on the Bernoulli's theory. METHOD: From a total of 20 case of vascular accesses for hemodialysis, of at least 3 months of construction, we twicely measured the AVF flow rate (QD) with Doppler ultrasonography and vascular conduit pressure. Four kinds of pressure were measured: tubing set free from dialysis machine and positioned on the patient's bed (PrF), two kinds of artificial stenosis made with tourniquet (PrS1, PrS2), pump flow rate at 100ml/min (Pr100), and pump off (Pr0). We calculated the flow rate of vascular conduit (QF) with PrF and mean arterial pressure on Bernouli's equation, and QF was compared with QD. RESULT: AVF was 26.0+/-28.6 (3~108) months after operation, with five cases (including 2 PTFE grafts) using brachial artery. PrF was closely correlated with Pr100 (R2=0.914), and inversely correlated with QD (R2=-0.026). QF was poorly correlated with QD (R2=0.003). There was no statistical difference in the double pressure measurement (P>0.05), but there was differenence in QD (P<0.05). When artificial stenosis was made, the pressures increased, and the calculated flow rates decreased in every patients. Thrombosis or stenosis was detected in all patients with decrement of QF, but not in all with decrement of QD. CONCLUSION: Pressure measurement and calculated flow rate in dialysis vascular conduit represent alterations of AVF flow rate. However its value in long-term follow up awaits further study with accurate constant number.
Arterial Pressure ; Arteriovenous Fistula ; Brachial Artery ; Constriction, Pathologic ; Dialysis ; Humans ; Polytetrafluoroethylene ; Renal Dialysis ; Thrombosis ; Tourniquets ; Ultrasonography, Doppler

Organ shortage remains a main obstacle to the development of organ transplantation for end stage organ disease. Identification of potential donors is a key point of donation/transplantation process. We evaluated the entire potential organ donor developed in intensive care unit and emergency room to find out the way to improve the real donation program .Pro-and retrospective analysis were performed in death patient occurred in intensive care unit and emergency room between May. 1997 and Oct. 1997. There are 394 death patients in ICU and 324 in ER during study period. 293 patients (74.3%) were eliminated by age under 1 year or over 70 years, and medical disease unsuitable for organ transplantation. After a series of elimination due to no possibility of brain death or organ unsutability, 35 patients (8.9%) finally were found to be a acceptable potential donors for organ transplantation in ICU, and 3 (0.9%) in ER. 28 of the 35 potential donors (80.0%) were found in neurology or neurosurgery ICU. Causes of brain death in 35 potential donors were traumatic intracerebral injury in 10 (29.4%), and non traumatic intracranial cerebral catastrophe in 21 (61.8%). Actual multiorgan harvest was performed in 2 (5.7%) among 35 medically acceptable potential donors in ICU. Three (8.6%) among 35 potential donors refused organ donation by donor families, 29 (82.9%) could not be actual donors due to absence of any information on organ donation to families of donors. Conclusively organ donation rate and efficacy from the potential donor are very poor in this series. Comprehensive donor action programs including practical donor detection program with donor linker, education program to medical staff and public are mandatory to increase the cadaveric organ donation effectively.
Brain Death ; Cadaver ; Critical Care* ; Education ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intensive Care Units* ; Kidney Transplantation* ; Medical Staff ; Neurology ; Neurosurgery ; Organ Transplantation ; Retrospective Studies ; Tissue and Organ Procurement ; Tissue Donors* ; Transplants

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hypo-osmotic hyponatremia. There are several etiologies of SIADH including neuroendocrine tumor, pulmonary disease, infection, trauma, and medications. Here, we report a case of SIADH associated with a schwannoma involving the mediastinum in a 75-year-old woman who presented with nausea, vomiting, and general weakness. Laboratory testing showed hypo-osmolar hyponatremia, with a serum sodium level of 102mmol/L, serum osmolality of 221mOsm/kg, urine osmolality of 382mOsm/kg, urine sodium of 55 mmol/L, and plasma antidiuretic hormone (ADH) of 4.40 pg/mL. Chest computed tomography identified a 1.5-cm-sized solid enhancing nodule in the right lower paratracheal area. A biopsy specimen was obtained by video-assisted thoracoscopic surgery, which was diagnosed on pathology as a schwannoma. The hyponatremia was completely resolved after schwannoma resection and plasma ADH level decreased from 4.40 pg/mL to 0.86 pg/mL. This case highlights the importance of suspecting and identifying the underlying cause of SIADH when faced with refractory or recurrent hyponatremia, and that on possibility is mediastinal schwannoma
Aged ; Biopsy ; Female ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Lung Diseases ; Mediastinum ; Nausea ; Neurilemmoma* ; Neuroendocrine Tumors ; Osmolar Concentration ; Pathology ; Plasma ; Sodium ; Thoracic Surgery, Video-Assisted ; Thorax ; Vomiting