When the tumor is advanced with distant metastasis or unresectable initially, preoperative chemotherapy could be applied in the treatment of Wilms' tumor We experienced 6 cases of favorable type of Wilms' tumor, 1 case of clear cell sarcoma and 1 case of renal cell carcinoma. They were treated with preoperative chemotherapy and underwent CT Scans before and after the therapy. Pathologic changes after chemotherapy in Wilms' tumor were known from previous reports as subtotal hemorrhagic necrosis, cystic change, clusters of foamy histiocytes, granulation tissue formation, primitive nephrogenic tissues and peripherally remained focal areas of blastemal infiltration. Changes of CT findings after chemotherapy were internal necrosis(6/6), decrease in size(5/6), decrease and absence of regional lymph node enlargement(4/6) and improved or disappeared metastatic lesions(3/3). Although our study had some limitations such as small numbers of cases and all cases were favorable types, we thought that there were good correlations between change of CT findings and subtotal hemorrhagic necrosis after preoperative chemotherapy in Wilms' tumor.
Carcinoma, Renal Cell ; Drug Therapy* ; Granulation Tissue ; Histiocytes ; Lymph Nodes ; Necrosis ; Neoplasm Metastasis ; Sarcoma, Clear Cell ; Tomography, X-Ray Computed ; Wilms Tumor

PURPOSE: The purpose of this study was to investigate the relationship between professional self-concept, role conflict and job satisfaction of emergency department (ER) nurse. METHOD: Data were collected from a convenience sample of 200 ER nurses who worked in one of 9 hospitals in 5cities. The instrument for this study was a structured questionnaire on professional self-concept, role conflict and job satisfaction. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, and multiple regression. RESULTS: The mean score for professional self-concept was 2.52 (0.28), for role conflict, 3.37 (0.55), and for job satisfaction, 2.71 (0.35). There were significant differences on three variables according to total career, and satisfaction with nursing. There was a significant positive correlation between professional self-concept and role conflict, job satisfaction. Role conflict showed a significant negative correlation with job satisfaction. CONCLUSION: The results of this study indicate that the important role-related variables of professional self-concept, role conflict and job satisfaction of ER nurses are significantly related, and that as, role conflict is an important factor for job satisfaction of ER nurses, strategies to decrease role conflict need to be developed.
Emergencies ; Job Satisfaction ; Professional Role ; Surveys and Questionnaires

PURPOSE: The degree of radiation-induced lung fibrosis (RILF) can be measured quantitatively by fibrosis volume (VF) on chest computed tomography (CT) scan. The purpose of this study was to investigate the interobserver and intraobserver variability in CT-based measurement of VF. MATERIALS AND METHODS: We selected 10 non-small cell lung cancer patients developed with RILF after postoperative radiation therapy (PORT) and delineated VF on the follow-up chest CT scanned at more than 6 months after radiotherapy. Three radiation oncologists independently delineated VF to investigate the interobserver variability. Three times of delineation of VF was performed by two radiation oncologists for the analysis of intraobserver variability. We analysed the concordance index (CI) and inter/intraclass correlation coefficient (ICC). RESULTS: The median CI was 0.61 (range, 0.44 to 0.68) for interobserver variability and the median CIs for intraobserver variability were 0.69 (range, 0.65 to 0.79) and 0.61(range, 0.55 to 0.65) by two observers. The ICC for interobserver variability was 0.974 (p < 0.001) and ICCs for intraobserver variability were 0.996 (p < 0.001) and 0.991 (p < 0.001), respectively. CONCLUSION: CT-based measurement of VF with patients who received PORT was a highly consistent and reproducible quantitative method between and within observers.
Carcinoma, Non-Small-Cell Lung ; Evaluation Studies as Topic* ; Fibrosis* ; Follow-Up Studies ; Humans ; Lung* ; Observer Variation* ; Radiotherapy ; Thorax ; Tomography, X-Ray Computed

The effect of various drugs on the incidence and severity of hypertension, tachycardia and emergence phenomena associated with ketamine anesthesia were investigated in many studies. Lorazepam is a psychotropic agent of the benzodiazepine class. similar in action to, but more potent than, diazepam. This study was carried out to investigate the efficiency of the ketamine I.V. drip technique under endotracheal intubation with a combination of nitrous oxide, oxygen, muscle relaxant and controlled ventilation. The only contraindications to the use of this technique were hypertension, a history of cerebrovascular disease or psychotic upset. Eighteen patients, ranging in age from 20 to 60 years, were premedicated with I.M. atropine sulfate and oral lorazepam (2mg/kg) administration. Anesthesia was induced with 1.5~2,0mg/kg ketamine and 0.03~0.04mg/kg alcuronium, before intubation. Anesthesia was maintained by dripping 0. l% ketamine in 5% dextrose in water, with N2O and 02, The average dosage of ketamine was l. 685mg/kg for induction and 0.011mg/kg/min for maintenance during operations with a duration of from 55 to 275 minutes. Alcuronium is a non-depolarizing muscle relaxant and a derivative of C-toxiferine l. It has a little ganglionic blocking effect. The increase of blood pressure after endotracheal intubation was not significant. The incidence of complications of anesthesia was increased blood pressure 16. 7% (20mmHg above preop. value), tachycardia 38. 9% , dreams 5. 6 % and hallucination 5. 6%. Also oral premedication with lorazepam provided significant anterograde amnesia in all patients. It may be concluded that a combination of oral premedication by lorazepam and ketamine I.V. drip anesthesia with N2,O, O2 and alcuronium, followed by endotracheal intubation, can be used relatively satisfactorily in explo-laparatory operations in which muscle relaxation is needed.
Alcuronium ; Amnesia, Anterograde ; Anesthesia ; Anesthesia, Endotracheal* ; Atropine ; Benzodiazepines ; Blood Pressure ; Cerebrovascular Disorders ; Clinical Study* ; Diazepam ; Dreams ; Ganglion Cysts ; Glucose ; Hallucinations ; Humans ; Hypertension ; Incidence ; Intubation ; Intubation, Intratracheal ; Ketamine ; Lorazepam ; Muscle Relaxation ; Nitrous Oxide ; Oxygen ; Premedication ; Tachycardia ; Ventilation ; Water

PURPOSE: Spontaneous isolated superior mesenteric artery dissection (SISMAD) is defined as superior mesenteric artery (SMA) dissection without an associated aortic dissection. SISMAD is an uncommon mesenteric ischemia, but can lead to death if not recognized early. Here, we present our experience on features characterizing SISMAD in an early period and review imaging findings. METHODS: Twelve symptomatic SISMAD patients who received conservative treatment between March 2005 and February 2012 were included in this study. Their clinical characteristics, imaging findings, treatment methods and outcomes were retrospectively analyzed. A diagnosis of SISMAD was confirmed by multidetection computed tomography (MDCT) and computed tomographic (CT) angiography. RESULTS: All patients complained of severe (6 patients) or moderate abdominal pain (6 patients), and 4 patients complained of radiating back pain at the same time. Eight patients had an acute onset (< or =3 days) of abdominal pain, and 4 patients had a chronic onset of the abdominal pain. The abdominal pain was located in the upper abdomen in 7 patients and in the periumbilical area in 5 patients. Angiographic types of SISMAD were classified into Sakamoto's type I (3 patients), type II (1), type III (4), and type IV (4). The dissection occurred within 3 cm from the orifice of the SMA in 9 patients (75%). The angiographic type of SISMAD was not associated with clinical symptoms and treatment methods. Ten out of 12 patients were treated with conservative management such as expectation and anticoagulation. Aneurysmal dilation of the SMA was noted in 4 patients, and 2 patients out of these 4 underwent surgical operations due to persistent abdominal pain and a growing aneurysm. No patients had a recurrence of symptoms and lesion progression on follow-up CT angiography. CONCLUSION: Patients with an acute onset of severe abdominal pain or chronic persistent abdominal pain should be suspicious of SISMAD and CT angiography should be performed.
Abdomen ; Abdominal Pain ; Aneurysm ; Angiography ; Back Pain ; Diagnosis ; Follow-Up Studies ; Humans ; Ischemia ; Mesenteric Artery, Superior* ; Methods ; Recurrence ; Retrospective Studies

In 2018, The Ministry of Health and Welfare announced its first comprehensive plan for patient safety, which included the imperative to develop a patient safety curriculum for students studying to become health professionals. The aim of this study is to assess current patient safety education and points of consideration for introducing new curriculum. An online survey was used to understand the status of patient safety education in medical schools, and key informant interviews and focus group interviews were used to collect qualitative data on the experience of patient safety education. The results of the online survey from 16 out of 40 medical schools (40% response rate) and the qualitative data analysis were integrated and analyzed. Twelve schools (75%) had established courses related to patient safety. The qualitative responses suggest that patient safety education is appropriate both before and after clinical training through a variety of educational methods, and that the topics should be linked with clinical training. The challenge of securing lecture time to address patient safety was mentioned as a realistic obstacle. When patient safety education is integrated in future curriculum, it is necessary to consider it as a priority. Moreover, in the early stages of introducing patient safety education, a step-by-step, policy-based approach is required for seamless adoption and settlement.

PURPOSE: The purpose of this study was to describe the essence of the experiences of patients in an ICU, and to understand them from the patients' point of view. METHODS: Participants in this study were six patients in P hospital. Data collection consisted of in-depth interviews and an observation method done from January to April in 2005. The method was analysis using the phenomenological method proposed by Colaizzi(1978). RESULTS: The themes were classified into eight theme clusters. The eight theme clusters were finally grouped into four categories, 'shock', 'pain', 'gratefulness' and 'pleasure of revival'. CONCLUSION: The ICU patients had negative experiences in physical.mental critical situations, but also positive experiences in consolation and nurses and families' encouragement. Therefore, ICU nurses must support patients and their families to minimize the negative experiences and maximize the positive experiences.
Adult ; Aged ; Attitude to Health ; Critical Illness/psychology ; Female ; Humans ; Inpatients/*psychology ; *Intensive Care Units ; Interviews as Topic ; Male ; Middle Aged ; Nursing Methodology Research ; Patient Transfer ; Qualitative Research

PURPOSE: The purpose of this study was to understand the experiences of mental health hospital workers. METHODS: Participants in the study were a total of 8 mental health hospital workers who consisted of nurses, social welfare workers and health managers. To prevent them from being omitted, the interviews were all recorded under the participants prior agreement. The method was analysis using the phenomenological method proposed by Colaizzi(1978). RESULTS: The experiences of the participants of this study were classified into 15 significant areas, from which 10 subjects hard work, conflicts, heavy feeling, irritability, getting familiar, changes of recognition, aptitude determination, feeling of achievement and sense of pride were drawn out. These subjects were then grouped into 5 themes. These five themes were finally grouped into 5 categories, negative emotion, depressive emotion, changes of thinking, delight and value discovery. CONCLUSIONS: The study tried to analyze the experiences of key informants like nurses, social welfare workers and health managers all of whom were serving at mental health hospitals, contribute to social recognition about the special medical establishment, promote qualitative mental health nursing and further provide educational information necessary for understanding mental health hospital workers.
Health Personnel/*psychology ; Helping Behavior ; Hospitals, Psychiatric ; Humans ; Interviews as Topic ; *Mental Health ; Models, Nursing ; Nursing Staff, Hospital/*psychology ; Workplace/psychology

BACKGROUND AND OBJECTIVES: In Korea, there hasn't been any previous literature that describes auscultatory blood pressure (BP) normative tables for adolescents. Using BP data, from the Korean National Health and Nutrition Examination Survey (KNHANES), we created normative auscultatory BP percentile tables for Korean adolescents. SUBJECTS AND METHODS: A total of 3508 adolescents (boys 1852, girls 1656), aged 10-17 in 2001, 2005 and 2007 from the KNHANES database years, were included. Auscultatory BP measurement was performed, using a Baumanometer Mercury Gravity Sphygmomanometer. RESULTS: The mean systolic BP of boys was higher than that of girls in adolescents older than 13 years of age, and the mean diastolic BP of boys was higher than that of girls in those older than 15 years. Systolic and diastolic BP was correlated with weight, height and age. Age-specific normative auscultatory systolic and diastolic BP percentiles for boys and girls were completed. The graph that showed age-specific prehypertensive and hypertensive systolic and diastolic BP for boys and girls was presented. For adolescents, the height-specific auscultatory BP percentiles for boys and girls were completed. A graph that shows the height-specific prehypertensive and hypertensive BP for boys and girls was also made. CONCLUSION: The auscultatory age-and height-specific BP percentiles for Korean adolescents are established. These can be useful in screening the prehypertension and hypertension of Korean adolescents in a clinical setting.
Adolescent ; Aged ; Auscultation ; Blood Pressure ; Gravitation ; Humans ; Hypertension ; Korea ; Mass Screening ; Nutrition Surveys ; Prehypertension

BACKGROUND: Ventilator associated pneumonia (VAP) is the most serious nosocomial infection of intensive care units. Several studies have investigated the relationship between the interval of ventilator circuit changes and the incidence of pneumonia in foreign countries, but there are no reports about it in Korea yet. So we performed this study to compare the clinical and cost impact between 3 days and 7 days interval in ventilator circuit changes. METHODS: Seoul National University Hospital is a 1,500-bed, university affiliated, tertiary and acute care hospital. All patients admitted to medical intensive care unit (MICU) and surgical intensive care unlt (SICU) between April 1, 1998 and October 31, 1998, requiring mechanical ventilation were included. Patients were divided into two groups of a-cay circuit changes and weekly changes. Daily surveillance was conducted using the criteria of VAP of the National Nosocomial Infection Surveillance System. Incidence of VAP and risk factors for VAP were evaluated. Standard microbiologic methods were used for the identification of clinical and environmental isolates. Statistical analysis was done by SAS Program (version 6.12), analysis of difference in variables was performed using chi-square test and t-test. Analysis of odds ratios was done with logistic regression analysis. RESULTS: VAP developed at a rate of 12.2 per 1,000 ventilator-days in the 3 days change group and 15.6 per 1,000 ventilator-days in the weekly change group (P=0.7240). The only statistically significant risk factor of VAP was duration of mechanical ventilation, The risk of VAP in patients with more than 7 days was 2.23 times higher than in patients with 7 days and below (OR; 2.2296). Estimated annual savings of nursing time by extending ventilator circuit change interval from 3 days to 7 days were 26,806 min 48 sec and estimated savings of cost by reduction of nursing times was calculated as 6,701,700 won. CONCLUSIONS: Weekly ventilator circuit changes in patients undergoing ventilation therapy in the ICU do not contribute to increased the rates of VAP and are cost-effective.
Cross Infection ; Humans ; Incidence ; Income ; Critical Care ; Intensive Care Units ; Korea ; Logistic Models ; Nursing ; Odds Ratio ; Pneumonia ; Pneumonia, Ventilator-Associated* ; Prospective Studies* ; Respiration, Artificial ; Risk Factors ; Seoul ; Ventilation ; Ventilators, Mechanical