In air leak syndrome, a significant portion of the volume delivered during a positive pressure breath can be lost through the leak. HFOV can achieve adequate ventilation at lower peak and/or mean intrapulmonary pressure than conventional mechanical ventilation (CMV) and has been an effective treatment of already established air leak syndrome. We report a 1-day-old male infant with severe respiratory failure from pneumothorax and pneumomediastinum, who was refractory to CMV with chest tube drainage. HFOV was applied to this patient for 114 hours, and improvement of oxygenation and ventilation as well as significant reduction of pneumothorax followed.
Chest Tubes ; Drainage ; Humans ; Infant ; Male ; Mediastinal Emphysema ; Oxygen ; Pneumothorax ; Respiration, Artificial ; Respiratory Insufficiency ; Ventilation*

BACKGROUND: Left ventricular hypertrophy is a major cardiovascular risk factor for sudden death, acute myocardial infarction and congestive heart failure. The left ventricle is generally thought to adapt to sustained arterial hypertension with increased total peripheral resistance by developing concentric hypertrophy. In recent years, the echocardiogrphy has been developed as a noninvasive method for evaluation of left ventricular geometry and left ventricular mass. However, left ventricular adaptation to hypertension has been shown to be more complex than expected. In fact, many patients with mild to moderate hypertension exhibit normal left ventricular mass and wall thickness, other hypertensive patients have eccentric ventricular hypertrophy that is not related to systolic dysfunction, but rather to increased cardiac output and preload and in some hypertensive patients absolute and relative wall thickness is increased with normal ventricular mass(concentric remodeling). There are differences in the hemodynamics, systolic function and diastolic function in each group. METHODS: From september 1992 to August 1994, in 144 patients with untreated essential hypertension and 50 age and gender matched normal adults studied by two-dimensional, M-mode and Doppler echocardiography. In the present study we used echocardiographically derived left ventricular mass and relative wall thickness to assess the patterns of ventricular geometric adaptation to systemic hypertension and their relations to systemic hemodynamics, left ventricular load and contractile performance. RESULTS: Hypertensive group was 144 cases(M:F=68:76), the mean age 56+/-13years. Normotensive group was 50 cases(M:F=22:28), the mean age 52+/-9years. Among hypertensive patients, left ventricular mass index and relative wall thickness were normal in 42 cases(29%), 24 cases(17%) had increased relative wall thickness with normal ventricular mass(concentric remodelin),48 cases(33%) had both increased relative wall thickness and ventricular mass(concentric hypertrophy), 30 cases(21%) had increased left ventricular mass with normal relative wall thickness(eccentric hypertrophy). Concentric hypertrophy and normal left ventricle group are more common in untreated hypertensive patients in Korea. Systemic hemodynamics showed tendency to paralleled ventricular geomety. In groups with concentric remodeling and hypertrophy, perpheral resistance was increased. Cardiac index was midly increased in eccentric hypertrophy. Diastolic dysfunction was prominent tn concentric hypertrophy. CONCLUSION: Each patterns of left ventricular geometry had different systemic hemodynamics, ventricular pressure overload and ventricular volume overload. Therefore, appropriate selection of antihypertensive agent for the patients with each patterns of hypertrophy reduce the left ventricular hypertrophy and may improve the prognosis.
Adult ; Cardiac Output ; Death, Sudden ; Echocardiography ; Echocardiography, Doppler ; Heart Failure ; Heart Ventricles ; Hemodynamics ; Humans ; Hypertension* ; Hypertrophy ; Hypertrophy, Left Ventricular* ; Korea ; Myocardial Infarction ; Prognosis ; Risk Factors ; Vascular Resistance ; Ventricular Pressure

PURPOSE: The purpose of this study was to explore the level of professional self-concept, self-efficacy and job satisfaction among nurses who work at hemodialysis units. METHODS: With convenience sampling, 128 nurses working at hemodialysis settings in Chungcheong Province were participated in this study. Data were analyzed using SPSS/WIN 14.0 with descriptive statistics, t-test, ANOVA, and Pearson correlation coefficient. RESULTS: The mean scores were 2.68 for professional self-concept, 3.65 for self efficacy and 3.14 for job satisfaction. There were significant differences in professional self-concept according to age, religion, position and clinical experience. There was statistically significant difference in self-efficacy according to age. Also, there was statistically significant difference in job satisfaction according to age, marital status, hospital type, position, clinical experience, and the number of patients per nurse. Job satisfaction was positively correlated with professional self-concept and self-efficacy. CONCLUSION: These findings provided that interventions to enhance professional self-concept as well as the strategies to improve self-efficacy are very important.
Humans ; Job Satisfaction ; Marital Status ; Renal Dialysis ; Self Efficacy

Purpose: The purpose of this study was to investigate the effects of uncertainty and spousal support on infertility-related quality of life in women undergoing assisted reproductive technologies. Methods: In this correlational survey study, 172 infertile women undergoing assisted reproductive technologies for infertility treatment at M hospital in Suwon participated. Data collection took place at the outpatient department of M hospital using a self-report questionnaire from July to August 2019. Data were analyzed using SPSS for Windows version 28.0. Results: The mean scores for uncertainty, spousal support, and infertility-related quality of life were 28.35 (out of 50), 86.67 (out of 115), and 57.98 (out of 100), respectively. Infertility-related quality of life was positively correlated with spousal support and negatively correlated with uncertainty. According to the regression analysis, infertility-related quality of life was significantly affected by uncertainty, total number of assisted reproductive technology treatments, marriage duration, subjective health status, the financial burden of infertility testing, and the presence of a burdensome person. These variables had an explanatory power of 35.0% for infertility-related quality of life. Conclusion Uncertainty was an important factor influencing infertility-related quality of life among women undergoing assisted reproductive technologies. It is necessary to develop and implement a nursing intervention program focused on reducing various forms of uncertainty during assisted reproductive procedures and to consider other factors affecting infertility-related quality of life in the clinical setting.

Purpose: Social distancing and strict visitor restrictions at hospitals have been national policies since the onset of the coronavirus disease 2019 (COVID-19) pandemic. This has challenged the concept of a good death in comfort with the opportunity to say goodbye.Little is known about how these measures have influenced end-of-life (EOL) care among cancer patients who die in acute care hospitals. This study examined changes in the EOL care of cancer patients during the COVID-19 pandemic. Methods: We retrospectively analyzed 1,456 adult cancer patients who died in 2019 (n=752) and 2020 (n=704) at a tertiary hospital. Data on EOL care—symptom control and comfort care in an imminently dying state, preparation for death, place of death, and aggressive care in the last month— were reviewed. Results: The 1,456 patients had a median age of 67 years, and 62.5% were men. Patients who died in 2020 were more likely to experience agitation or delirium before death (17.2% vs. 10.9%), to use inotropes/vasopressors near death (59.2% vs. 52.3%), and to receive cardiopulmonary resuscitation in their last months (16.3% vs. 12.5%) than those who died in 2019. Additionally, the number of deaths in the emergency room doubled in 2020 compared to 2019 (from 7.1% to 14.1%). Conclusion This study suggests that EOL care for cancer patients who died in a tertiary hospital deteriorated during the COVID-19 pandemic. The implementation of medical care at the EOL and the preferred place of death should be discussed carefully in advance for high-quality EOL care.

PURPOSE: Methylphenidate (MPH) is an effective medication for the treatment of attention deficit hyperactivity disorder (ADHD). However, about 30% of patients do not respond to or are unable to tolerate MPH. Based on previous findings, we hypothesized that great variability in response time (RT) among Korean children with ADHD on a computerized continuous performance attention test would be related to poor MPH treatment response. MATERIALS AND METHODS: Children (ages 6-18 years) with ADHD were recruited for a prospective 12-week, open-labeled, multicenter study to examine optimal dosage of OROS methylphenidate. Of the 144 subjects selected, 28 dropped out due to adverse events, medication noncompliance, or follow-up loss, and an additional 26 subjects with comorbid disorders were excluded from statistical analyses. We defined 'responders' as subjects who received a score of less than 18 on the attention deficit hyperactivity disorder rating scale (ARS; Korean version, K-ARS) and a score of 1 or 2 on the Clinical Global Impression-Improvement scale (CGI-I). RT variability was assessed with the ADHD diagnostic system (ADS). RESULTS: Fifty-nine (67%) subjects responded to MPH treatment. The non-responders showed greater RT variability at baseline (Mann Whitney U = 577.0, p < 0.01). Baseline RT variability was a significant predictor of MPH response (Nagelkerke R2 = 0.136, p < 0.01). It predicted 94.9% of responder, 17.2% of non-responder and 69.3% of overall group. CONCLUSION: High RT variability may predict poor response to MPH treatment in children with ADHD.
Adolescent ; Attention Deficit Disorder with Hyperactivity/*drug therapy ; Child ; Female ; Humans ; Korea ; Male ; Methylphenidate/*therapeutic use ; *Reaction Time ; Treatment Outcome

BACKGROUND: It is generally known that the principle treatment of obesity is life-style modification and behavior therapy for weight reduction. This study was carried out to investigate the effect of office-based education for weight control and behavior modification in overweight patients. METHODS: We selected 119 patients among the overweight or obese (BMI >or=23 kg/m2) patients who visited the Department of Family Medicine at Asan Medical Center. Life styles such as diet, exercise, smoking, and alcohol drinking were evaluated by self-questionnaire. Weight, height, body mass index, waist circumference, waist to hip ratio, and body fat were measured. The patients were divided randomly into two groups, the intervention (n=60) and the control (n=59) group. We educated the intervention group about the importance of weight reduction, life-style modification and provided specific guidelines. Two months later, we measured anthropometric variables and evaluated changes of behavior modification. RESULTS: After two months, 28 patients of the intervention group and 22 patients of the control group were followed up. At the follow-up time, the body weight and waist circumference decreased significantly in the intervention group compared with those of the control group. The exercise time increased significantly in the intervention group compared to the control group. The frequency of fatty meal ingestion decreased significantly in the intervention group. CONCLUSIONS: The office-based education for weight reduction in overweight or obese patients has contributed substantially in changing their life-style and reducing their waist circumference. As a result, we have found that patient education for behavior modification was essential part of comprehensive approach for weight control in overweight patients.
Adipose Tissue ; Alcohol Drinking ; Behavior Therapy* ; Body Height ; Body Weight ; Chungcheongnam-do ; Diet ; Eating ; Education ; Follow-Up Studies ; Humans ; Life Style ; Meals ; Obesity ; Overweight* ; Patient Education as Topic* ; Smoke ; Smoking ; Waist Circumference ; Waist-Hip Ratio ; Weight Loss

PURPOSE: To investigate the efficacy of ultrasound (US)-guided core biopsies after digital mammography-guided two-dimensional localization (DM-2DL) of breast microcalcifications. MATERIALS AND METHODS: Twenty-two patients with 23 suspicious microcalcifications underwent US-guided core biopsies after DM-2DL, to mark the sites on the skin where microcalcifications had been found (craniocaudal and mediolateral (or lateromedial) views). Of the 23 lesions, 4 were sampled using a 14-gauge automated gun and the other 19 were sampled using an 8-gauge vacuum-assisted device. The lesions were categorized into two groups: those with and those without microcalcifications observed on US. The success rate for correctly sampling microcalcifications on the specimen radiograph in the two groups was assessed and their pathologic outcomes were investigated. RESULTS: Of the 23 lesions, 16 were invisible and 7 were visible to ultrasonographic microcalcifications. The sampling success rate for the specimen radiographs was 100% for ultrasonographic visible microcalcifications and 88% (14/16) for lesions invisible to ultrasonography after DM-2DL (p = 1.000). The cancer rate of individuals with microcalcifications observed on US (57%, 4/7) was greater than in individuals without visible microcalcifications (13%, 2/16) (p=0.045). CONCLUSION: Although some microcalcifications are invisible on US, a US-guided biopsy after DM-2DL is a useful method for the successful sampling of the microcalcifications.
Biopsy ; Breast ; Humans ; Mammography ; Skin

Sinus histiocytosis with massive lymphadenopathy known as Rosai-Dorfman disease is characterized by painless bilateral cervical lymphadenopathy. Extranodal manifestations are uncommon and spinal involvement is rare. A 15-year-old man presented with intermittent midthoracic back pain only. He had no specific findings on neurologic examinations, hematologic and biochemical laboratory tests. Radiological examination of thoracic spine revealed collapse of T6 vertebrae with thoracic kyphosis and osteolytic lesion of T12 vertebra body. He underwent a removal of bone tumor, anterior reconstruction with mesh and pedicle screw fixation via posterior approach for pathologic confirmation and stabilization. Histopathologic study of the lesion revealed focal infiltration of large histiocytes showing emperipolesis. Immunochemistry stain of histiocytes was positive for CD68 and S-100 but negative for CD1a. This report presents a rare case and literature review of extranodal Rosai-dorfman disease in thoracic spine.
Adolescent ; Back Pain ; Emperipolesis ; Fractures, Compression* ; Histiocytes ; Histiocytosis, Sinus* ; Humans ; Immunochemistry ; Kyphosis ; Lymphatic Diseases ; Neurologic Examination ; Spine*

The aim of this study was to investigate the prevalence and correlates of depressive symptoms in the largest number of Korean individuals examined to date. We analyzed cross-sectional data collected from 229,595 Korean adults aged 19 yr and above who participated in a Korean Community Health Survey conducted in 2009. The Center for Epidemiologic Studies Depression Scale (CES-D) was used as the measurement tool for depressive symptoms (CES-D score over 16) and definite depression (CES-D score over 25). Multivariate logistic regression analysis was performed to identify associations between sociodemographic factors and depressive symptoms. The percentages of depressive symptoms and definite depression in the total study population were 11% (7.8% for men, 14.0% for women) and 3.7%, (2.4% for men, 5.0% for women), respectively. Female gender, older age, disrupted marital status, low education and income level, multigenerational household composition and metropolitan residence were associated with greater risk of depressive symptoms. The present study provides a valid prevalence and correlates of depressive symptoms, using the largest representative sample of the Korean general population to date. Various sociodemographic factors contribute to the prevalence and effects of depressive symptoms in Korea.
Adult ; Age Factors ; Aged ; Asian Continental Ancestry Group ; Cross-Sectional Studies ; Depression/*epidemiology ; Female ; Health Surveys ; Humans ; Logistic Models ; Male ; Marital Status ; Middle Aged ; Odds Ratio ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; Sex Factors ; Social Class ; Socioeconomic Factors ; Young Adult