The purpose of this study is to build up the foundation to prepare the effective nursing intervention devices for the seriously ill patient's families nursing through the nurse understanding of the experiences of the seriously ill patient's families in the field by setting up grounded theory. In this study, the subjects is the 6 families members of ICU patients, who were being cared in university hospital and the data were collected from 4.15 to 5, 1996 by the recordings and transcring the interview. The intervention lasted from 2 hours to 2 and a half hours. The data were analyzed in the framework of grounded theory as mapped out by Strauss & Corbin. The core category in the analysis of the experiences of the families of the seriously ill patients was the process of setting the "distress". In the process of datas analysis, the categories were 19 conceptions-'serious', 'bad', 'fear', 'press', 'hearburn', 'impatient', 'insufficient', 'change of patients' status', 'economic ability', 'family relationship', 'whilled power', 'request', 'direct caring', 'passive effort', 'control', 'receive', 'tired', 'blame'. These categories were again grouped into 12 categories, including 'exigency', 'overwhelming', 'worry', 'change of status', 'economic ability', 'relationship', 'caring will' 'active caring', 'passive response', 'accept', 'exhaustion', 'blame'. In the above mentioned categories, 'overwhelming' and 'worry' were categorized into the "distress!". On the basis of the patterns that have emerged on process of data analysis, the five below were confirmed. (1) When the patient's status is worse and economic ability is bad and the family relation to the patient is close and the distress is expressed with active caring willness is strong, the distress is expressed with active caring and brings about accept and blame. (2) When the family relation to the patient is distant and the distress decrease and the subject's caring willness is weak, the distress is expressed with passive response and brings about accept and exhaustion in spite of the patient's status is worse and bad economic ability. (3) When the patient's status is worse and economic ability is bad and the family relation to the patient is close and the distress increase, the subject's caring willness is strong, the distress is subject's caring willness is strong, the distress is expressed with passive response and brings about accept and exhaustion. (4) When the patient's status is improve and economic ability is good and the distress decrease and the subject's caring willing is strong, the distress is expressed with active caring and brings about accept and blame in spite of the family relation to the patient is close. (5) When the patient's status is improve and economic ability is bad and the family relation to the patient is close and the distress increase, the subject's caring willness is strong, the distress is expressed with active caring and brings about accept and blame.
Family Relations ; Humans ; Nursing ; Statistics as Topic

Medroxyprogesterone acetate(MPA) is one of the most commonly used hormonal agents for the treatment of advanced or recurrent endometrial adenocarcinoma. However, the progesterone receptor content of endometrial carcinoma varies directly to the degree of differentiation and inversely with stage of the tumor. Thus one would predict that MPA therapy would be less effective in advanced and poorly differentiated tumors. In addition, MPA has been shown to reduce progesterone receptor content of both normal and malignant endometrial cells, which could result in loss of hormone responsiveness. Tamoxifen, which is often used in breast cancer therapy, has also been used in the treatment of patients with advanced and recurrent endometrial carcinoma. Tamoxifen is known to have some estrogenic effects at low concentration and one of these effects is induction of progesterone receptor both in normal and malignant endometrium. This property has focused interest on sequential or simultaneous use of tamoxifen and MPA in the therapy of endometrial carcinoma. The growth inhibitory effects of MPA and tamoxifen were tested on six longestablished endometrial carinoma cell line(HEC-1-A, HEC-1-B, RL 95-2, AN3CA, KLE) and on SCHE-1, a new endometrial carcinoma cell line established in our laboratory. MPA and tamoxifen were used in growth experiments either alone, simultaneously or sequentially. The MCF-7 breast cancer cell line was used as a control. Only 20% reduction in cell number was achieved after 10 days of exposure to the drug, even with the highest MPA concentration tested(10micronm) in endometrial carcinoma cell lines. But in MCF-7 cells, 60% reduction in cell number was achieved with the same concentration of MPA(10um). Ten days of feeding with 5micronm tamoxifen produced a 96% reduction in cell number in MCF-7, a 91% reduction in HEC-1-A, a 88% reduction in HEC-1-B, a 98% reduction in AN3CA and a 71% reduction in KLE cultures. In SCHE-1 cultures a 83% reduction in cell growth was seen and no viable cells remainde in RL 95-2 cultures after 10 days of feeding with a 5uM tamoxifen. In AN3CA cultures, simultaneous exposure to 5um tamoxifen and 5um MPA resulted in partial reversal of the tamoxifen-induced growth inhibition. In RL 95-2, HEC-1-A and HEC-1-B cultures, simultaneous use of these drugs had the same effect as tamoxifen alone, whereas in KLE and SCHE-1 cultures a slight additive growth effect was observed. All six endometrial carcinoma cell lines resumed logarithmic growth when medium containing tamoxifen of logarithmic growth under these conditions was slower than that in the other endometrial carcinoma cultures. Our results show that MPA does not have growth inhibitory effects in these endometrial carcinoma cell cultures, whereas tamoxifen has been shown to have potent endometrial carcinoma cells. These findings are of special importance since patients who are most likely to need adjuvant therapy for advanced or recurrent endometrial carcinoma are those with estrogen receptor and progesterone receptor negative tumors.
Adenocarcinoma ; Breast Neoplasms ; Cell Count ; Cell Culture Techniques ; Cell Line* ; Endometrial Neoplasms* ; Endometrium ; Estrogen Receptor Modulators* ; Estrogens ; Female ; Humans ; MCF-7 Cells ; Medroxyprogesterone ; Receptors, Progesterone ; Tamoxifen*

Since the placenta is an organ composed of blood vessels, it is not surprising that its primary neoplasm would be a vascular tumor. Placental tumors, primary or secondary, have been known to interfere with placental function. Chorioangioma(primary tumor of the placenta), which is the most common of them, occurs with an incidence for clinically significant ranges from 1~2.8:10000 births. These tumors are benign and are not usually associated with clinical sequelae unless they are larger than 5cm in long diameter. About one third of the large chorioangiomas may be associated with the maternal and fetal complications. For diagnosis of these lesions, the ultrasonography was used. If the chorioangioma is suspected, color doppler study is informative to confirm the presence of the vascular channels. We reviewed ultrasonograms and clinical records of seven patients who had been diagnosed as placental chrioangioma. The appropriate diagnostic tests and treatment can then be initiated in order to prolong gestation and decrease fetal mortality and morbidity.
Blood Vessels ; Diagnosis ; Diagnostic Tests, Routine ; Fetal Mortality ; Hemangioma* ; Humans ; Incidence ; Parturition ; Placenta* ; Pregnancy ; Prenatal Diagnosis* ; Ultrasonography

PURPOSE: Screening mammography is now a widely used procedure and as result, the incidence of ductal carcinoma in situ (DCIS) of the breast is increasing. The purpose of this study was to investigate the incidence and clinicopathologic features of DCIS and to evaluated the difference of clinical characteristics between breast conserving surgery and mastectomy. METHODS: We reviewed the clinical record of 112 patients with DCIS, including those with microinvasion, who were treated at the Department of Surgery, Keimyung University Hospital from January 1992 to December 2005. RESULTS: The incidence of DCIS and microinvasive carcinoma was 8.0% of all the breast cancers. The most prevalent age was in the fifth decade and the mean age was 48.8 years old. An abnormality on routine health screening exams was the most common cause of detection. Preoperatively, the diagnostic methods were fine needle aspiration biopsy in 7.6%, core needle biopsy in 19.0%, needle localization open biopsy in 33.3% and excisional biopsy in 40.0%. The surgical procedures were modified radical mastectomy or simple mastectomy in 48.2% and a breast conservation procedure in 51.8%. The final surgical margin status showed a free margin in 83.0%, a close margin in 12.8%, and an involved margin in 4.3%. The hormonal receptor positive rate was 75.3% and the c-erbB-2 positive rate was 32.9%. The patient who received mastectomy had a larger tumor size, a more common presentation of microcalcification on MMG, a more frequent comedo type lesion and a lesser expression of hormonal receptor. There was no significant difference between the two groups in terms of the c-erbB-2 expression. CONCLUSION: The widespread use of screening mammography will increase the chance to detect DCIS, and conservative surgery will be performed more frequently in a selected group of these patients.
Biopsy ; Biopsy, Fine-Needle ; Biopsy, Large-Core Needle ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Humans ; Incidence ; Mammography ; Mass Screening ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Mastectomy, Simple ; Needles

This study was performed to investigate the effect of octreotide on the contractility of rat vas deferens. The -smooth muscle strips isolated from the prostatic portion were myographied in isolated organ bath. Electric -field stimulation (monophasic square wave, duration : 1. mSec, voltage : 50 V, frequency : 5 Hz or 30 Hz, train : 10 Sec) produced reproducible contraction. The contraction was composed of two component, first phasic component (FPC) and second tonicc component (STC).. These contractions were abolished by -tetrodotoxin (1 microM). Octreotide inhibited the field stimulation induced contractions both FPC and STC concentration- dependently. The FPC was decreased by a desentization of purinergic receptor by pretreatment of mATP, and the STC was decreased by pr,,creatment of reserpine (3 mg/kg, EP) 24 hours before experiments. Octreotide reduced the field stimulation induced contraction in the presence of mATP and of reserpinized muscle strips. The inhibitory effect of octreotide was more potent at 5 Hz than at 30 Hz. Octreotide did not affect basal ton and exogenous norepinephrine- or ATP-induced contraction. These results suggest that octreotide inhibit the contractility of the isolated rat vas deferens by inhibition of the release of neurotransmitters, both ATP and norepinephrine from adrenergic nerve terminal.
Adenosine Triphosphate ; Animals ; Baths ; Neurotransmitter Agents ; Norepinephrine ; Octreotide* ; Rats* ; Reserpine ; Vas Deferens*

In this report we describe twenty-two cases of intracranial tumors studied with an MR imager operating at a field strength of 0.064 T for evaluation of the clinical utility of low tesla MRI. The comfirmed diagnoses were meningioma(9 cases), astrocytoma(4 cases), glioblastoma multiforme(1 case), craniopharyngioma(2 cases), intracranial metastasis(1 case). pituitary microadenoma (1 case), hemangioblastoma (1 case), and trigerminal neurilemmoma(1 case). Meningiomas appeared as well-marginated, homogenous signal intensity masses(67%) in most cases. Most meningiomas showed iso-signal intensity(78%) on T1-weighted images, and high signal intensity on T2-weighted images. After Gd-DTPA enhancement, diffuse homogeneous contrast enhancement(75%) was well see. The multiple hemorrhagic foci within the glioblastoma multiforme were identified, which shoed high signal intensity on T1-weighted images and low signal intensity on T2-weighted images(intracellular methemoglobin), or high signal intensity on both T1 and T2-weighted images(extracellular methemoglobin). One case of cerebellar hemangioblastoma was a well-defined cystic mass with contrast enhanced mural nodule but no identification of characteristic signal void vessels. The remianing tumors showed low signal intensity on T1-weighted images, and high signal intensity on T2-weighted images. Gd-DTPA enhancement was helpful in separating the lesion from the surrounding edema or normal tissue, but had limited diagnostic value in characterizing the nature of the mass. The advantages of low tesla MRI are as follows on requirement of cooling water or electricity, open design, shorter T1 relaxation time compared with high tesla unit that increases the difference of T1-relaxation time between tissues, ease of installation, and cost effectiveness. In conclusion, the low tesla MRI is useful for the detection and evaluation of the brain tumors.
Brain Neoplasms ; Cost-Benefit Analysis ; Diagnosis ; Edema ; Electricity ; Gadolinium DTPA ; Glioblastoma ; Hemangioblastoma ; Magnetic Resonance Imaging ; Meningioma ; Relaxation ; Water

Ewing's sarcoma is an uncommon primary bone tumor. Primary Ewing's sarcoma of the cranium is extremely rare and constitutes only 1% of all Ewing's sarcoma cases. Usually, primary Ewing's sarcoma of the carnium manifests as an expansile osteolytic malignant bone tumor with or without intracranial extension. We report here the radiological findings of a case of Ewing's sarcoma mimicking a meningioma in an 18-year-old man.
Adolescent ; Diagnosis, Differential ; Humans ; Meningioma* ; Sarcoma, Ewing* ; Skull ; Skull Neoplasms

OBJECT: This study was performed in order to examine the correlation between acute neuroleptic-induced dystonic reactions and serum iron level. METHOD: Serum iron levels were measured in psychiatric inpatients who had developed acute neuroleptic-induced dystonia(N=41) and in control patients with no history of acute dystonic reactions(N=37). Serum iron levels were compared in acute dystonic inpatients before starting treatment with neuroleptics and after acute dystonic reaction. RESULTS: The patients exhibiting acute dystonic reactions had significantly lower serum iron levels than the patients without acute dystonic reactions. CONCLUSION: This result supports an association between low serum iron and the occurrence of neuroleptic-induced acute dystonic reactions.
Antipsychotic Agents ; Dystonia* ; Humans ; Inpatients ; Iron*

OBJECTIVE: The purpose of this study was to compare the plasma amitriptyline and nortriptyline level between before and after fluoxetine addition with patients who were currently taking amitriptyline. METHOD: From the inpatient and outpatient unit of Soon Chun Hyang University Hospital, Chunan, fourteen subjects who were taking amitriptyline 25mg more than 1 week at least were given fluoxetine 20mg. Before and 2 weeks after fluoxetine addition the plasma level of amitriptyline and nortriptyline are analyzed simultaneously by High Performance Liquid Chromatography(HPLC) At the same times, HAM-D(Hamilton Rating Scale for Depression) score and the UKU(Uldvalg for Klinske Unders phi gelser) side effect scale were checked. RESULTS: After fluoxetine addition to the patients who were taking amitriptyline, the plasma level of amitriptyline, nortriptyline and sum of amitriptyline and nortriptyline had risen. The mean plasma amitriptyline level increased from 168.9+/-89.4ng/ml to 183.0+/-102.0ng/ml after fluoxetine addition(p=0.011) but the change was not statistically significant. The mean plasma nortriptyline level increased significantly from 114.3+/-70.2ng/ml to 168.0+/-86.2ng/ml after fluoxetine addition(p=0.011) In addition, the mean plasma level of total amitriptyline and nortriptyline increased significantly from 283.1+/-125.3ng/ml to 350.9+/-78.4ng/ml after fluoxetine addition(p=0.016) After fluoxetine addition, no significant change was noted in the UKU side effect scale score. CONCLUSION: As consequence of comparson of plasma amitriptyline and nortriptyline level before and after fluoxetine addition mean amitriptyline, nortriptyline and total plasma level was increased after fluoxetine addition. This suggests that coadministration of amitriptyline and fluoxetine may induce improvement of depressive symptom in depressive patients by way of increased plasma level of amitriptyline.
Amitriptyline* ; Chungcheongnam-do ; Depression ; Fluoxetine* ; Humans ; Inpatients ; Nortriptyline ; Outpatients ; Plasma*

Fracture of the scaphoid constitute 60% to 70% of all diagnosed carpal injury. The acute fracture will heal approximately 90% of the time if recognized early and properly immobilized. But nonunion are common since the symtoms do not alert patients to seek early medical treatment and the diagnosis is easily missed. Authors have experienced 19 cases of scaphoid nonunion and accomplished good result in all case by Russe procedure. The results were summerized as follow: 1 The cause of fratures was mainly due to fall down dinjury (36.8%). 2. The most common mechanism of the fracture was fall on the outstretched hand (52.7%). 3. Fractures were shown on the anterior-posterior, lateral and billiards view in all cases. 4. In ten cases, the fractures were found on the waist of scaphoid. 5. The cases of nonunion were probably inadequate intial treatment and delayed diagnosis. 6. The good results were obtained by bone graft according to Russe procedure.
Delayed Diagnosis ; Diagnosis ; Hand ; Humans ; Transplants