Perigraft seroma is uncommon complication of polytetrafluoroethylene(PTFE) grafts applied as an arteriovenous shunt for hemodialysis. It is a collection of clear, sterile fluid confined to nonsecretory fibrous pseudomembrane, most commonly localized around the middle and distal portion of graft. The possible etiologic factors of perigraft seroma include poor graft incorporation, mechanical graft damage caused by alcohol and povidone-iodine, intraoperative streching of the graft, variations in quality control at the time of manufacture and contributing factors such as anemia and coagulopathy in uremia. The best strategy for management of perigraft seroma is not clear. spiration or drainage alone is not effective, and some authors advocate graft removal. We report a case of perigraft seroma around arterial end of PTFE graft along with a brief review of the literatures.
Anemia ; Drainage ; Humans ; Polytetrafluoroethylene ; Povidone-Iodine ; Quality Control ; Renal Dialysis* ; Seroma* ; Transplants ; Uremia

PURPOSE: This meta-analysis was conducted to evaluate the effects of a self-efficacy promoting program and analyze its components. METHOD: The material used for this study were 18 self-efficacy promoting program studies carried out from Jan. 1980 to Oct. 2003. The studies were analyzed in different categories: 1) types of dependent variables 2) sample characteristics 3) types of experimental treatment conditions 4) types of self-efficacy source and 5) total amount of time RESULT: 1) The weighted mean of a self-efficacy promoting program ranged from 1.383 to 0.015 2) for the experimental treatment condition, exercise had a much larger effect in increasing general self-efficacy and self-care than education 3) the studies using 3 sources had a much larger effect in increasing self-care than the studies using 4 sources 4) a time period longer than 900 minutes had a much larger effect in increasing specific self-efficacy, general self-efficacy and self-care than in a time period shorter than 900 minutes. 5) effect size of specific self-efficacy was significantly higher than general self-efficacy. CONCLUSION: These results can be used to guide the development of a self-efficacy promoting program for nursing practice.
Humans ; *Patient Education as Topic ; *Self Care ; *Self Efficacy

BACKGROUND: Laryngoscopy and tracheal intubation for general anesthesia are potent stimuli to the cardiovascular system due to sympathetic stimulation. The aim of this study was to compare the hemodynamic responses with different administration routes of lidocaine on blood pressure and heart rate changes associated with tracheal intubation. METHODS: Sixty patients were randomly assigned to spray group (Group 1, n=20) received 10% lidocaine 1.5 mg/kg spray to intratracheally immediately before tracheal intubation, IV group (Group 2, n=20) received 2% lidocaine 1.5 mg/kg intravenously before 90 sec tracheal intubation and control group (Group 3, n=20). Anesthesia was induced with thiopental 5 mg/kg IV, vecuronium 0.1 mg/kg and 50% N2O-O2- 2vol % enflurane. After 5 minutes, tracheal intubation was performed. Mean arterial pressure and heart rate were measured at preintubation and immediately postintubation, 1, 3, 5 mins after tracheal intubation. RESULTS:The differences of mean arterial pressure which were measured at preintubation and immediately postintubation and 1 minute after intubation in group 1 were significantly lower than those in other group (p<0.05). The differences of heart rate which measured at preintubation and 1 minute after intubation were lower than those in group 3 (p<0.05). CONCLUSIONS: For the suppression of sympathetic stimulation following tracheal intubation, 10% lidocaine spray to the laryngotrachea is an effective method to suppress cardiovascular response.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Cardiovascular System ; Enflurane ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Intubation* ; Laryngoscopy ; Lidocaine* ; Thiopental ; Vecuronium Bromide

OBJECTIVES: The purpose of this study was to investigate effects of structural and functional characteristics of social network on social adjustment in people with mental illness. METHODS: 236 members of the people with mental illness who were enrolled in day hospital, community mental health center and social rehabilitation center participated in the survey. RESULTS: Of structural and functional characteristics of social network, the influenced factors on social adjustment were network size of professional, social support (family, friend and professional) and conflict with professional. When controlling socio-demographic and disorder characteristics, this regression model affected significantly on social adjustment but the power of influence reduced slightly. CONCLUSION: In order to improve the social adjustment of people with mental illness, it is necessary for social network to provide them with more emotional and social resources. Especially, it is important for mental health professionals to build active partnership with the people with mental illness as consumer. For people with mental illness, the economic stability through guaranteed income such as disability benefits, and occupational rehabilitation is very important.
Friends ; Hospitals, Community ; Humans ; Mental Health ; Rehabilitation Centers ; Social Adjustment

PURPOSE: This study was done to investigate the relationship among the variables, chronic pain, pain coping, fatigue, self-esteem, and depression in elders. METHOD: Data were collected by self-reported questionnaires from 270 older adults. Data analysis was done with SPSS 10.1 for descriptive statistics and a PC LISREL program for covariance structural analysis. RESULTS: According to modified model, chronic pain was found to have a significant direct and total effect on pain coping. Chronic pain and pain coping were found to have a significant direct and total effect on fatigue. Chronic pain, pain coping and fatigue were found to have a significant direct and total effect on self-esteem. Chronic pain, pain coping, and self-esteem were found to have a significant direct effect on depression. CONCLUSION: This modified model is considered appropriate for explaining the relationship among chronic pain, pain coping, fatigue, self-esteem, and depression in elders. Also, the findings support the development of an intervention strategy to relieve chronic pain in elders.
Adult ; Chronic Pain* ; Depression* ; Fatigue* ; Humans ; Surveys and Questionnaires ; Self Concept ; Statistics as Topic

PURPOSE: We wanted to evaluate the sonographic features of adenosis tumor of the breast. MATERIALS AND METHODS: We evaluated the sonographic findings of 9 lesions in 9 patients who had a diagnosis of adenosis tumor after excision. The mean age of the patients was 32 years. All the masses were palpable. The sonographic features were interpreted by the ACR-BI-RADS (American College of Radiology Breast Imaging Reporting and Data System). Three of the women underwent mammography. RESULTS: The mean size of the lesion was 2.4 cm, and the shape of the masses was oval (n=9). The orientation was parallel (n=9). The margin was circumscribed (n=7), angular (n=1) and microlobulated (n=1). The lesion boundary was an abrupt interface (n=9). The echo pattern was hypoechoic (n=8) and isoechoic (n=1). Posterior acoustic enhancement was seen in 7 masses, and the other 2 masses showed combined shadowing and enhancement. The final assessment categories were classified into category 3 (n=7) and category 4 (n=2). Mammograms performed in 3 patients revealed a circumscribed mass in 2 patients and negative findings in 1 patient. CONCLUSION: Adenosis tumor of the breast usually shows as an oval, parallel oriented, circumscribed, hypoechoic mass with posterior acoustic enhancement on sonography.
Acoustics ; Breast ; Diagnosis ; Female ; Humans ; Mammography ; Shadowing (Histology) ; Ultrasonography

PURPOSE: To report a case of bilateral central retinal vein occlusion (CRVO) as one of the initial signs of disseminated intravascular coagulation (DIC). CASE SUMMARY: A 33-year-old woman with a history of pregnancy-induced thrombotic thrombocytopenic purpura presented to our hospital with bilateral visual loss. On her initial visit, visual acuity was counting fingers at 30 cm in both eyes. Based on the findings of a funduscopic examination, the patient was diagnosed with bilateral CRVO. Laboratory tests confirmed the diagnosis of DIC combined with thrombotic thrombocytopenic purpura (TTP). Plasma exchange and transfusion of cryoprecipitate with fresh frozen plasma was performed. The ocular fundus findings did not improve. Despite medical treatment, the patient's systemic condition deteriorated and she died of metabolic acidosis two weeks later. CONCLUSIONS: Bilateral central retinal vein occlusion occurred as a sign of aggravation of preexisting TTP and progression to DIC in the presented case. In patients with severe bilateral retinal venous changes, there should be a very high level of suspicion for presence or progression of systemic disease, with the possibility of effective early systemic evaluation and therapy.
Acidosis ; Adult ; Dacarbazine ; Disseminated Intravascular Coagulation ; Eye ; Female ; Fingers ; Humans ; Plasma ; Plasma Exchange ; Purpura, Thrombotic Thrombocytopenic ; Retinal Vein ; Retinaldehyde ; Thymine Nucleotides ; Visual Acuity

BACKGROUND: Opioids are increasingly being administered intrathecally as adjuncts to local anesthetics. They enhance spinal anesthesia without prolonging motor recovery. We evaluated the effect of 10 microgram of fentanyl to bupivacaine on sensory, motor block and side effects. METHODS: Thirty six patients undergoing urologic surgery were randomized into two groups. Control group received bupivacaine 10 mg combined with normal saline 0.2 ml, and Fentanyl group received bupivacaine 10 mg with fentanyl 10 microgram (0.2 ml). RESULTS: There were no significant differences between two groups in the peak level of sensory block, onset of peak level, duration of motor block, and side effects. However, the time of regression from peak level to T10 in Fentanyl group was longer significantly than that of Control group. CONCLUSIONS: Intrathecal small dose fentanyl (10 microgram) on bupivacaine spinal blockade prolonged duration of sensory block and did not augment side effects and provide reliable anesthesia for urologic surgery.
Analgesics, Opioid ; Anesthesia ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine* ; Fentanyl* ; Humans

BACKGROUND: Tracheal intubation by direct laryngoscopy induces frequently transient hypertension, tachycardia and arrhythmia. The purpose of this study was to examine the effect of esmolol and clonidine in attenuating the changes of blood pressure and heart rate by tracheal intubation. METHODS: Eighty patients were randomly divided into four groups: Group 1 (control , n=20), Group 2 (esmolol 0.5 mg/kg IV, n=20), Group 3 (clonidine 4 mcg/kg PO, n=20) and Group 4 (clonidine 4 mcg/kg PO and esmolol 0.5 mg/kg IV, n=20). The clonidine premedication were given orally with a sip of water 90 minutes before induction of anesthesia. Anesthesia was induced with thiopental 5 mg/kg, vecuronium 0.1 mg/kg, 50% nitrous oxide in oxygen and 2 vol % enflurane. After 5 minutes, tracheal intubation was performed. Patients in the group 2 and group 4 were given esmolol 0.5 mg/kg 90 seconds prior to tracheal intubation. Blood pressure and heart rate were measured at ward, preinduction, preintubation, immediately after intubation, 1, 3 and 5 minutes after intubation. RESULTS: After tracheal intubation, the increase in systolic blood pressure was supressed significantly in the clonidine-treated patients (Group 3, Group 4) compared with control group (p<0.05). The attenuating effect on increase of mean arterial pressure(MAP) was sustained longer in group 4 than group 3. Heart rate increased after tracheal intubation in all groups, but were markedly increased in the control group (p<0.05). The differences of MAP which measured at preinduction and immediately postintubation were smaller in group 4 than control group (p<0.05). The differences of heart rate which measured at preinduction and immediately postintubation were smaller in group 4 than group 1 or group 3 (p<0.05). CONCLUSIONS: Esmolol 0.5 mg/kg given as bolus, is effective for controlling the increase of heart rate but not in attenuating increase of blood pressure. Oral clonidine is effective for controlling the increase of blood pressure but not in attenuating increase of heart rate. Therefore esmolol combined with oral clonidine results in effective control of both heart rate and blood pressure.
Anesthesia ; Arrhythmias, Cardiac ; Blood Pressure ; Clonidine* ; Enflurane ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation* ; Laryngoscopy ; Nitrous Oxide ; Oxygen ; Premedication* ; Tachycardia ; Thiopental ; Vecuronium Bromide ; Water

PURPOSE: The purpose of this study was to analyze the histologic concordance of sonographically guided core needle biopsy for phyllodes tumors or fibroepithelial lesions with cellular stroma of the breast by comparing this with the outcomes of excision biopsy and to identify any sonographic features that are helpful to predict phyllodes tumors. MATERIALS AND METHODS: We retrospectively reviewed 60 breast masses that were diagnosed as phyllodes tumors (n = 43) or fibroepithelial lesions with cellular stroma (n = 17) on a sonographically guided core needle biopsy. The tumors were all subsequently excised by surgery. The sonographic features were compared between the phyllodes tumors and the non-phyllodes tumors according to the results of excision biopsy. RESULTS: By the results on excision biopsy, there were 48 (80%) phyllodes tumors and 12 (20%) non-phyllodes tumors. Phyllodes tumors were diagnosed at a rate of 90.7% (39/43) for the nodules with phyllodes tumors on the sonographically guided core needle biopsy, and at a rate of 52.9% (9/17) for the nodules with fibroepithelial lesions with cellular stroma on the sonographically guided core needle biopsy. On sonography, heterogeneous internal echotexture (58% vs. 17%, respectively, p = 0.0239), clefts (56% vs. 17%, respectively, p = 0.0331) and horizontal linear striations (71% vs. 33%, respectively, p = 0.0221) were significantly more frequent in the phyllodes tumors than that in the non-phyllodes tumors. CONCLUSION: Identification of a heterogeneous-internal echotexture, clefts and horizontal linear striations on sonography might help differentiate phyllodes tumors from non-phyllodes tumors.
Biopsy ; Biopsy, Large-Core Needle ; Breast ; Needles ; Phyllodes Tumor ; Retrospective Studies