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.

BACKGROUND/AIMS: Serum HBV DNA levels are correlated with hepatic histologic activity in chronic HBV infection based on HBeAg. Liver injury may persist, even though HBV DNA are not detected by hybridization assay. This study was to investigate whether serum HBV DNA levels determined by more sensitive quantitative method are correlated with histologic activities in chronic HBV infections. METHODS: This study included 66 chronic HBV infected patients. HBV DNA level was quantified by Cobas Amplicor HBV Monitor(TM). RESULTS: Serum HBV DNA levels in HBeAg-positive patients were significantly higher than HBeAg-negative patients. In HBeAg-positive patients, serum HBV DNA levels showed a significant negative correlation with portal-periportal activity and fibrosis (r=-0.451, -0.446 respectively). AST levels were correlated with lobular, portal-periportal activity and fibrosis (r=0.432, 0.365, 0.301 respectively), whereas ALT levels were related to lobular activity (r=0.294). Elevated AST levels predicted lobular activity, portal-periportal activity, and fibrosis with moderate to severe degree (OR 1.733, 95% CI 1.083-2.775; OR 1.518, 95% 1.028-2.243, p=0.336; OR 17.897, 95% CI 1.517-211.208, p=0.022, respectively). CONCLUSIONS: In HBeAg-positive patients, serum HBV DNA level correlates inversely with histologic activity. On the other hands AST level correlates with histologic activity and the stage of moderate or severe degree.
Adolescent ; Adult ; Child ; Child, Preschool ; DNA, Viral/*blood ; Female ; Hepatitis B e Antigens/analysis ; Hepatitis B virus/genetics/*isolation & purification ; Hepatitis B, Chronic/pathology/*virology ; Humans ; Liver/*pathology ; Male ; Middle Aged

BACKGROUND/AIMS: The Dieulafoy lesion is an important cause of gastrointestinal bleeding. The bleedings from caliber- persistent vessel or abnormally large and tortuous submucosal artery are usually located on proximal stomach. Endoscopic band ligation (EBL) is currently regarded as the treatment of choice of Dieulafoy lesions. This study reports on the clinical features, the efficacy and safety of EBL. METHODS: 10 patients with Dieulafoy-like lesion (median age: 47 yr range: 22~71, M:F 8:2 ) were treated using EBL. EBL was performed as the primary hemostatic tratment as follows in 8 cases of urgency and 2 cases of emergency. RESULTS: The location of all lesions (n=10) were in stomach, 8 in body (4 in posterior wall), 2 in fundus. The bleeding focuses were identified during the first endoscopy. Five lesions were bleeding, 5 had adherent clots or protruding vessels without active bleeding. Hemostasis were achieved with first session of EBL in 9 patients successfully, one case in the fundus was failed due to early band release. CONCLUSION: EBL is a simple, effective, and safe endoscopic method of Dieulafoy-like lesions and, it should be proposed as a primary option.
Arteries ; Emergencies ; Endoscopy ; Hemorrhage ; Hemostasis ; Humans ; Ligation* ; Stomach

BACKGROUND/AIMS: Recent studies have reported the potentials of endoscopic papillary large balloon dilatation (EPLBD) with minor endoscopic sphincterotomy (EST) for the complete removal of common bile duct (CBD) stone in the high risk groups. However, there have been no reports about the recurrence of the CBD stone after EPLBD with minor EST. The aim of this study was to evlauate the recurrence of CBD stone after EPLBD with minor EST. METHODS: A total of 1,036 patients who underwent endoscopic treatment due to CBD stones at Pusan University Hospital were enrolled. The patients were classified into two groups: those who underwent EPLBD with minor EST (group 1) and those who underwent EST treatment (group 2). We investigated clinical factors and recurrence rate between two groups. RESULTS: The recurrence of CBD stone occurred in total of 74 patients (7%), and the recurrence rates of CBD stone were 21/321 (6.5%) in Group 1 and 53/715 (7.4%) in Group 2. There were no difference in the presence of diverticulum and the number and size of recurrent CBD stone between the two groups. In case of diverticulum existence, recurrence rates were 12/158 (7.6%) in Group 1 and 21/101 (20.8%) in Group 2. When compared to the case of no diverticulum existence (Group 1: 9/163 [5.5%], Group 2: 32/614 [5.2%]), the recurrence rate of CBD stone was significantly lower if treated after EPLBD with minor EST (p<0.01). CONCLUSIONS: CBD stone that recurs after going through EPLBD with minor EST can be successfully removed with an endoscopic treatment. The recurrence of CBD stone was especially lower in cases with periampullary diverticulum and treated with EPLBD with minor EST. Our results will be helpful in endoscopic retreatment and preventing the recurrence of CBD stone.

BACKGROUND: Although intraoperative opioids provide more comfortable anesthesia and reduce the use of postoperative analgesics, it may cause opioid induced hyperalgesia (OIH). OIH is an increased pain response to opioids and it may be associated with N-methyl-D-aspartate (NMDA) receptor. This study aimed to determine whether intraoperative nefopam or ketamine, known being related on NMDA receptor, affects postoperative pain and OIH after continuous infusion of intraoperative remifentanil. METHODS: Fifty-four patients undergoing laparoscopic cholecystectomy were randomized into three groups. In the nefopam group (N group), patients received nefopam 0.3 mg/kg at the induction of anesthesia followed by a continuous infusion of 0.065 mg/kg/h. In the ketamine group (K group), patients received ketamine 0.3 mg/kg at the induction of anesthesia followed by a continuous infusion of 3 µg/kg/min. The control group did not received any other agents except for the standard anesthetic regimen. Postoperative pain score, first time and number of demanding rescue analgesia, OIH and degrees of drowsiness/sedation scale were examined. RESULTS: Co-administrated nefopam or ketamine significantly reduced the total amount of intraoperative remifentanil and postoperative supplemental morphine. Nefopam group showed superior property over control and ketamine group in the postoperative VAS score and recovery index (alertness and respiratory drive), respectively. Nefopam group showed lower morphine consumption than ketamine group, but not significant. CONCLUSIONS: Both nefopam and ketamine infusion may be useful in managing in postoperative pain control under concomitant infusion of remifentanil. However, nefopam may be preferred to ketamine in terms of sedation.
Analgesia ; Analgesics ; Analgesics, Opioid ; Anesthesia ; Cholecystectomy, Laparoscopic* ; Humans ; Hyperalgesia ; Ketamine* ; Morphine ; N-Methylaspartate ; Nefopam* ; Pain, Postoperative*

BACKGROUND: In this Study, we investigated the effects of lifestyle and metabolic syndrome on free oxygen radical levels in men and women in Korea. METHODS: A total of 254 adults were included in this study from February 2011 to June 2012 at a health promotion center. Information of the lifestyles and presence of metabolic syndrome factors was obtained. Biochemical markers were measured and free oxygen radicals test (FORT) was performed on the blood. RESULTS: Of the 254 subjects, 86 (33.9%) had metabolic syndrome, and 187 (73.6%) were men. Between the subjects with and without metabolic syndrome, there was a significant increase in alanine aminotransferase and serum FORT values in the subjects with metabolic syndrome. Multiple linear regression analysis showed that high-sensitivity C-reactive protein (hs-CRP) (P = 0.004), metabolic syndrome (P = 0.037), and female gender (P = 0.030) were independent predictors of serum FORT values. The subjects with high fasting blood sugar level or low high density lipoprotein cholesterol levels showed high serum FORT values. CONCLUSION: High hs-CRP, the presence of metabolic syndrome, and female gender were associated with the high oxidative stress. High oxidative stress was associated with the presence of metabolic syndrome.
Adult* ; Alanine Transaminase ; Biomarkers ; Blood Glucose ; C-Reactive Protein ; Cholesterol ; Cholesterol, HDL ; Fasting ; Female ; Health Promotion ; Humans ; Life Style ; Linear Models ; Lipoproteins ; Male ; Oxidative Stress* ; Oxygen ; Reactive Oxygen Species

BACKGROUND: The term 'portal biliopathy' has been used to describe abnormalities of the extrahepatic and intrahepatic bile ducts in patients with portal hypertension, especially those with extrahepatic portal vein obstruction. The aim of this study was to delineate the clinical features and imaging findings of portal biliopathy. METHODS: Clinical and imaging data of 15 patients who had portal biliopathy from April 2001 to March 2005 were reviewed. Two radiologists working in concensus analyzed the imaging finings and each radiologist and gastroenterologist made a comparison between MRCP and ERCP. RESULTS: Of the 15 patients with portal biliopathy, there were 7 men and 8 women and their mean age was 56.4 years (range, 24 to 78 years). Most of them were unknown origin (11/15, 73%) and 4 patients combined with recurrent pyogenic cholangitis. 4 patients presented with obscure right abdominal pain, 3 had mild fever with chilling and others had no symptoms. Extrahepatic portal vein obstruction was replaced by cavernous transformation in all patients. 3 different types of biliary abnormalities were 3 pseudocholangiocarcinoma type, 8 varicoid type and 4 mixed type. Choledocholithiasis occuring 4 patients (2 CBD stone, 1 GB stone and 1 CBD with IHD stone). Correlation betwen MRCP and ERCP (or PTC) was identical and exact diagnosis was possible. During EST or cholecystectomy, no significant bleeding was found. CONCLUSIONS: On portal hypertension combined with biliary obstruction, portal biliopathy should be suspected as a possible diagnosis. Knowledge of these clinical features and imaging findings should facilitate accurate diagnosis of portal biliopathy.
Abdominal Pain ; Bile Ducts, Intrahepatic ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy ; Choledocholithiasis ; Diagnosis ; Female ; Fever ; Hemorrhage ; Humans ; Hypertension, Portal ; Male ; Portal Vein

Dieulafoy's lesion is an uncommon but important cause of massive upper gastrointestinal bleeding. The lesion usually occurs in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction but extragastric locations of Dieulafoy's lesion are rare. In this study, diagnosis of Dieulafoy's lesion was frequently made by endoscopy instead of surgery. Hemostasis was achieved by endoscopic treatment in more than 90% of patients. We report the successful application of endoscopic hemoclipping for treatment of active bleeding from Dieulafoy's lesion in the ampulla of Vater of the duodenum.
Ampulla of Vater* ; Diagnosis ; Duodenum ; Endoscopy ; Esophagogastric Junction ; Hemorrhage ; Hemostasis ; Humans ; Stomach

This is the first case report to describe a 44-year-old woman with a history of advanced hepatocellular carcinoma who developed toxic epidermal necrolysis (TEN) clinically after taking 400 mg sorafenib (Nexavar(R), BAY 43-9006) and tosufloxacin orally once per day. Both sorafenib and tosufloxacin were eventually discontinued, and the TEN resolved with corticosteroids and supportive treatment. Clinical physicians should be aware of this possible complication so that early interventions can be made.
Adrenal Cortex Hormones ; Adult ; Bays ; Carcinoma, Hepatocellular ; Early Intervention (Education) ; Epidermal Necrolysis, Toxic ; Female ; Fluoroquinolones ; Humans ; Naphthyridines ; Niacinamide ; Phenylurea Compounds

Lymphangioma is a benign tumor that is commonly found in children. Many lymphangiomas are congenital malfor- mations of the lymphatic system and they are considered to be lymphatic hamartomas. Lymphangiomas usually occur in the head, neck and axillary region, and they rarely occur in the gastrointestinal tract. Cystic lymphangioma is a rare cause of colonic submucosal masses. Lymphangioma of the colon has recently been diagnosed more frequently by performing colonoscopy and endoscopic ultrasonography. However, only a few cases of colonic intussusception due to lymphangioma have been reported in the literature. We experienced a case of intussusception that was caused by cystic lymphangioma of the colon, and we report here on the findings.
Child ; Colon* ; Colonoscopy ; Endosonography ; Gastrointestinal Tract ; Hamartoma ; Head ; Humans ; Intussusception* ; Lymphangioma ; Lymphangioma, Cystic* ; Lymphatic System ; Neck