BACKGROUNDS: The high mortality and morbidity rates associated with traumatic rupture of the hollow viscera have been attributed to the clinical difficulty in establishing an early diagnosis. The accuracy of CT in the detection of injuries of the solid visceral organ is well established, but the value of CT in diagnosing small bowel perforation artier blunt abdominal trauma is controversal. This study was conducted to ascertain CT findings of small bowel perforation result from blunt abdominal trauma. METHODS: A retrospective analysis of preoperative abdominal CT findings in 40 patients was performed. Small bowel perforation was confirmed by surgery. Precontrast and postcontrast enhanced CT images were obtained in all patients. RESULTS: Diagnostic findings of small bowel perforation including intraperitoneal or retroperitoneal free air, discontinuity of the bowel wall and extravasation of oral or IV contrast materials were observed in 34 cases(85%). The most common fading of small bowel perforation was intraperitoneal or retroperitoneal free fluid collection(90%), followed by segmental bowel wall thickening(83%), intraperitoneal or retroperitoneal free air(80%) and focal mesenteric fat infiltration(70%). CONCLUSIONS : The CT scan is sensitive and effective modality for evaluation of small bowel perforation after blunt abdominal truauma, because of high detectability of diagnostic antral suggestive CT findings.
Contrast Media ; Diagnosis* ; Early Diagnosis ; Humans ; Mortality ; Retrospective Studies ; Rupture ; Tomography, X-Ray Computed ; Viscera

BACKGROUND: Breast cancer is increasing cause of cancer-related mortality among Korean women. Early detection and treatment are the most important strategy for reducing breast cancer mortality. Despite of its importance as a early detection method, a low percentage of women practice breast self-examination(BSE) regularly. The aim of this study was to describe the effectiveness of patient education on performing BSE regularly and to identify predisposing factors associated with these activities. METHODS: Sixty-six women who did not have experience in BSE in the past were randomly assigned to the experimental group and the control group. We taught BSE knowledge and skill about BSE using breast models and audiovisual equipment for experimental group in patient education class. Women in control group, however, were simply educated by their physician about BSE knowledge and skill with only educational booklet during their outpatient visits. We observed the difference in regular BSE performance proportion between two groups 6, 12 months later and analyzed the predisposing factors affecting on the education effect. Direct and telephone interview methods were used to gather the information. Data were analyzed with t-test, x2analysis and logistic regression using SAS 6.10, EGRET program. RESULTS: There were no differences in sociodemographic characteristics between study groups. They were followed for 12 months. At follow-up after 6 months 44.1% of women performed BSE regularly among experimental group and 18.8% of women did it among control group(OR=3.4, 95% Cl 1.1-10.4, p<0.05). At follow-up after 12 months proportion of women performed BSE regularly in experimental group(28.6%) was slightly higher than that of control group(22.2%), but that difference was not statistically significant. The prevalence of performing BSE regularly was higher among women who had experience in periodic health examination(OR =6.0, 95% Cl 1.9-18.8, p<0.01), who had experience in mammography(OR =4.0, 95% Cl 1.0-15.6, p<0.05). And the prevalence of performing BSE regularly also was higher among women who were older than 40 years old, married, had experience in cervical Pap. smear, had knowledge about BSE before education, have done exercise regularly, had less number of health risk factors, but without statistical significance. CONCLUSIONS: These results showed that of effectiveness of patient education on BSE, if we determine the effectiveness of BSE education with regular performance of BSE, is relatively low among Korean women. We could see, however, that if we use breast models for demonstration in addition to usual educational material, the effectiveness of BSE education can be more effective. We also recognized that effectiveness of BSE education will not be continued for long time without any maintenance strategy. There were lots of predisposing factors which could affect the effectiveness of BSE education positively or negatively. So, family physicians who plan BSE patient education at their clinics must consider these factors.
Adult ; Breast Neoplasms ; Breast Self-Examination* ; Breast* ; Causality ; Education* ; Female ; Follow-Up Studies ; Humans ; Interviews as Topic ; Logistic Models ; Mortality ; Outpatients ; Pamphlets ; Patient Education as Topic ; Physicians, Family ; Prevalence ; Risk Factors

PURPOSE: Delirium in the elderly is common in the postoperative period but there are only few reports on detailed studies of this condition. Number of urologic patients with postoperative delirium was increas ed in our hospital for recent 24 months. The clinical characteristics of patients with postoperative delirium was analyzed retrospectively. MATERIALS AND METHODS: We selected the patients with postoperative delirium from 1010 patients who had undergone urological surgery under general or spinal anesthesia in the period from Jan. 1997 to Dec. 1999. Diagnosis of postoperative delirium was established with Diagnostic and Statistical Manual of Mental Disorders(DAM-III-R) by psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric disorder, relationship with anesthesia, drugs, and surgical procedures, concomittant medical conditions, and complications were retrospectively reviewed. RESULTS: Postoperative delirium was observed in 13 patients (1.3%). All patients were male and mean age was 70.4 years (46-86 years). Surgical procedures included TURP(8 patients), cystectomy (3 patients), nephroureterectomy (1 patient), and bladder rupture repair (1 patient). Delirium became apparent between one day and two days after the operation (mean 32.2 hours) and lasted for up to 7 days (mean 53 hours). Several factors such as older age (>65 years), male patient, longterm medication, past history of CVA, memory impairment, hearing difficulty, traumatic brain contusion, and obsessive personality were thought to be risk factors of postoperative delirium. Treatment with Haloperidol(R) intramuscular injection (2.5-5mg, every 30 minutes, 2-4 times until symptom resolution was achieved) with or without Ativan(R) intravenous injection (2mg) were effective. Complete symptom recovery was seen in 92.3% (12/13) of patients. One patient (7.7%) with previous history of dementia had persistent memory disturbance and disorientation during follow-up periods. CONCLUSIONS: Generally, postoperative delirium is an acute transient confusional state without considerable sequeles. Treatment is sedation and prevention of inadvertent accident associated with confusional state. Urologic surgeon must be attentive to the development of this illness especially when high risk factors were present.
Aged ; Anesthesia ; Anesthesia, Spinal ; Brain Injuries ; Cystectomy ; Delirium* ; Dementia ; Diagnosis ; Follow-Up Studies ; Hearing ; Humans ; Injections, Intramuscular ; Injections, Intravenous ; Male ; Memory ; Postoperative Period ; Retrospective Studies ; Risk Factors ; Rupture ; Urinary Bladder

No abstract available.

No abstract available.

Drowning is a leading cause of accidental deaths worldwide, but its pathological diagnosis remains a challenge for forensic pathologists owing to a lack of pathognomonic findings in drowning deaths and inconclusive autopsy findings caused by postmortem changes. The aim of the present study was to investigate the pathway taken by inhaled drowning medium through the airway after death in a variety of experimental conditions, including underwater pressurization. We used methylene blue dye to monitor the spread of drowning medium to the lungs. Results of theses experiments demonstrated that it is possible for a significant amount of downing medium to enter the airway during immersion after death. Our results suggest that autopsies of immersed bodies and interpretation of these findings should be performed with special care.
Animal Experimentation* ; Animals* ; Autopsy ; Diagnosis ; Drowning* ; Immersion ; Inhalation* ; Lung ; Methylene Blue* ; Postmortem Changes

PURPOSE: Lower caliceal stones treated with ESWL do fail to pass more frequently than middle or upper caliceal stones. We analyzed the results of ESWL of renal caliceal stones according to the location of calix. MATERIALS AND METHODS: We reviewed the stone-free rate in 119 caliceal stone patients treated with 3rd generation lithotriptor, EDAP LT-02 according to the caliceal location of the stone. Location of the stones were upper calix in 30, middle calix in 30, and lower calix in 59 patients. RESULTS: Stone-free rate was 90.0%(27/30 patients) in middle caliceal stones, 74.6%(44/59 patients) in lower caliceal stones, and 66.7%(20/30 patients) in upper caliceal stones. CONCLUSIONS: Stone-free rate of lower caliceal stones is higher than upper caliceal stones.
Humans ; Lithotripsy* ; Shock*

No abstract available.
Diazepam* ; Humans ; Hypnotics and Sedatives* ; Midazolam* ; Surgery, Plastic*

BACKGROUND: With the increase of cigarette consumption by women and the young, the incidence of lung cancer is expected to increase during the next three or four decades in Korea. The purpose of this study was to analyze the smoking habits in patients with lung cancer and to identify the gender differences in terms of their susceptibility to cigarette related carcinogens. METHODS: This investigation was a hospital-based case control study, which included the data of 178 case subjects(72 females, 106 males) with lung cancer and 218 control subjects(97 females, 121 males) with diseases unrelated to smoking. The information was obtained through a direct personal interview and a questionnaire related to personal smoking history. RESULTS: The relative frequency of the squamous cell carcinoma was substantially higher in males than in females(61.3% in males, and 29.2% in females), while adenocarcinoma including bronchoalveolar cell carcinoma was higher in females(31.9% in females, 18.9% in males). Keryberg Ilung cancer was of relatively higher frequencies in males and smokers. while Kreyberg IIlung cancer was higher in females and never smokers. The odds ratios(ORs) at each exposure level were consistently higher in females than males. For all cell types, the risk of lung cancer was increased with the quantity of smoked cigarettes, duration of smoking, and depth of inhalation. Odds ratio was distinctly higher in Kreyberg Ilung cancer than in total lung cancer and a steeper gradient of risk with increased smoking was observed in females. CONCLUSION: The ralative risk for lung cancer was consistently higher in females than in males at every level of exposure to cigarette smoke. This is believed to be due to the higher susceptibility of females to tabacco carcinogens, such as gender associated differences of carcinogen activation and/or the elimination of smoking related metabolites.
Adenocarcinoma ; Carcinogens ; Carcinoma, Squamous Cell ; Case-Control Studies ; Female ; Humans ; Incidence ; Inhalation ; Korea ; Lung Neoplasms* ; Lung* ; Male ; Odds Ratio ; Smoke* ; Smoking* ; Tobacco Products

Augumentation rhinoplasty using autogenous cranial bone graft (outer table) can be used more successfully than other methods. In patients with congenital or posttraumatic severe saddle nose deformity and lateral deviation, cranial bone graft is an excellent method of augumentation. The advantages of cranial bone graft compared with traditional method of bone graft are summarized as follows; 1. Easy to reach donor site 2. Abundance of material 3. Little pain and functional disability 4. Shorter hospitalization period 5. Inconspicuous donor scar 6. No secondary deformity of donor site 7.Appropriate curvature can be obtained by proper selection of donor site. With the above advantages, we conclude that augumentation rhinoplasty using split cranial bone graft is a good method in correction of congenital or posttraumatic deformity of nose.
Cicatrix ; Congenital Abnormalities ; Hospitalization ; Humans ; Methods ; Nose ; Rhinoplasty* ; Tissue Donors ; Transplants*