The diagnosis of thoracic outlet syndrome (TOS) is sometimes confused by its nonspecific symptoms and various etiologies. Moreover, the paths of involving nerves and arteries are highly diverse. We report a 35 year-old man who had numbness and coldness in his left upper extremity with no improvement to medical therapy. The electrophysiologic studies were normal. Radial artery pulse was absent and the thermography revealed markedly reduced temperature below the left mid-forearm. The arteriography showed compression of the left subclavian artery between the clavicle and the 1st rib with aneurysmal change proximal to the compression. Occlusion of the left brachial artery and collateral arteries were also observed. Under the diagnosis of vascular TOS, 1st rib resection was performed and his symptoms were relieved. Vascular TOS may be considered in cases of upper limb paresthesia.
Adult ; Aneurysm ; Angiography ; Arteries ; Brachial Artery ; Clavicle ; Diagnosis ; Embolism ; Humans ; Hypesthesia ; Paresthesia ; Radial Artery ; Ribs ; Subclavian Artery ; Thermography ; Thoracic Outlet Syndrome* ; Upper Extremity

PURPOSE: The purpose of this study was to investigate RN-BSN students' clinical nursing competency in order to establish baseline data for developing nursing competency based clinical education for RN-BSN students. METHOD: A survey of 1,453 RN-BSN students from 21 nursing schools was conducted using a self administered questionnaire. RESULT: The mean score of the clinical nursing competency was 2.93. The scores for competency were shown as 2.91 for nursing management, 2.94 for developing professionalism & legal implementation, 2.95 for critical thinking, 2.96 for teaching & leadership, and data collection, basic nursing care, and communication were above 3.00. The items perceived as insufficient competency were physical examination and observation & monitoring in data collection, cardiopulmonary resuscitation, psycho-social care, spiritual care, hospice in basic nursing care, application of knowledge and theory, formulating nursing diagnosis, nursing care planning in critical thinking, education material development, leadership, delegation in teaching and leadership, analysis of organization, planning, infection control, role & job description, evaluation of nursing activities in nursing management, quality improvement, and research in developing professionalism and legal implementation. CONCLUSION: This study will contribute to developing a nursing competency based on clinical education for RN-BSN students who have various education needs and clinical backgrounds.
Adult ; Analysis of Variance ; *Clinical Competence ; Curriculum ; Data Collection ; Education, Nursing, Associate/*standards ; Education, Nursing, Baccalaureate/*standards ; Female ; Humans ; Male ; Nursing Education Research ; Questionnaires ; *Students, Nursing

OBJECTIVE: To evaluate the anatomic course of the lateral antebrachial cutaneous nerve (LABCN) and medial antebrachial cutaneous nerve (MABCN) in the forearm. METHOD: We dissected 29 upper extremities of 16 cadavers for LABCN and 20 upper extremities of 15 cadavers for the MABCN. We measured the distance (BT_L) between the biceps tendon (BT) and LABCN on the intercondylar line. The BT is the point at which biceps tendon crosses intercondylar line. The distance (L12) between LABCN and the point of 12 cm distal to BT on the line between BT and radial artery at wrist was measured. The distance (ME_M) between MABCN and medial epicondyle on the intercondylar line was measured. M8 and M10 are the distances between MABCN and the points 8 cm and 10 cm distal to BT on the line from BT to mid-point of flexor carpi radialis and palmaris longus at the wrist respectively. RESULTS: BT_L and L12 were 1.4+/-3.7 mm and 4.4+/-3.7 mm respectively. ME_M, M8 and M10 were 28.6+/-6.9 mm, 18.9+/-8.9 mm and 18.3+/-8.2 mm respectively. The thickness of LABCN and MABCN was 19.1+/-4.9 mm and 13.2+/-4.2 mm respectively. CONCLUSION: The LABCN was emerge just lateral to biceps tendon at the elbow and ran down to radial artery. The anatomic course of MABCN was variable at the elbow and forearm.
Cadaver ; Elbow ; Forearm ; Radial Artery ; Tendons ; Upper Extremity ; Wrist

Multiple primary cancer is defined as the case of primary malignant tumors of different histologic origins each other in one person, The incidence of multiple primary cancer has been increasing recently due to more developed diagnostie procedure and long survival of cancer patients. In esophageal cancer patients, comibined prevalence of other malignancy is rela tively high. We have experienced three cases of gastric adenocarcinoma with esophageal squamous cell carcinoma and report these cases with a review of literatures.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Esophageal Neoplasms ; Esophagus* ; Humans ; Incidence ; Prevalence ; Stomach*

BACKGROUND: To establish effective preventive measures for hepatitis A virus (HAV) infection, a nationwide epidemiologic study on seroprevalence of anti-HAV and the disease prevalence is needed. The aim of this study was to analyze the recent sero-epidemiological changes of hepatitis A markers in Korea. METHODS: The results of 11,068 anti-HAV total and 32,360 anti-HAV IgM tests by electro-chemiluminescence immunoassay (ECLIA) that had been requested in recent four years (2005-2008) to a reference medical laboratory from 1,699 institutions nationwide were retrospectively analyzed according to the distribution of year, sex, and age groups. RESULTS: The overall positive rate of anti-HAV total was 62.8%. The overall positive rate of anti-HAV IgM was 11.0%, showing a significantly increasing trend by year: 7.7%, 10.9%, 8.9%, and 14.3% in 2005, 2006, 2007, and 2008, respectively (P<0.0001). The positive rate of anti-HAV IgM was higher in male than in female subjects (11.8% vs 10.0%, P<0.0001), and 81.8% (2,916/3,566) of the anti-HAV IgM positive results were observed in the age groups of 21-40 yr. The annual positive rates of anti-HAV total and anti-HAV IgM showed significantly decreasing and increasing trends, respectively, in the age groups of > or =21 yr. Conclusion: In accordance with a decreasing sero-positivity of anti-HAV total, the prevalence of acute hepatitis A virus infection has been considerably increased during the recent four years in the age groups of > or =21 yr. The results of this study could be used effectively as a basic data for establishing effective preventive measures for hepatitis A including vaccination in these susceptible age groups.
Adult ; Biological Markers/blood ; Chemiluminescent Measurements ; Enzyme-Linked Immunosorbent Assay ; Female ; Hepatitis A/*epidemiology ; Hepatitis A Antibodies/*blood ; Hepatitis A virus/*immunology ; Humans ; Immunoglobulin M/blood ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; Sex Factors ; Time Factors

Malposition of catheter in the subdural space is a possible complication during attempted epidural anesthesia. We report here an inadvertent subdural block confirmed by the radiographic contrast materiaL Epidural anesthesia was planned for a full-term gravida and epidural catheter was inserted about 3 cm cranially at the level of L1-2. After injection of 19.5 ml local anesthetic, blood pressure was 70/50 mmHg. Fluid was rapidly infused and intravenous ephedrine 10 mg was given. After then, vital signs were well maintained and twin babies were delivered without events. Twentyfive minutes later, she complained chest tightness and became tachypneic. Ketamine 50 mg was given and endotracheal intubation was performed with ease. She obeyed command, but could not open her eyes for some duration. Self respiration returned after 110 minutes and minute ventilation was 6 liter/minute at that time. 160 minutes later, extubation was done and radiological examination was performed using contrast materiaL The cathter tip was positioned in anterior subdural space at T12 level.
Anesthesia, Epidural* ; Blood Pressure ; Catheters ; Ephedrine ; Humans ; Intubation, Intratracheal ; Ketamine ; Respiration ; Subdural Space ; Thorax ; Twins ; Ventilation ; Vital Signs

Intracranial lipoma is a rare tumor. It is considered as congenital malformation, caused by poor differentiation and abnormal persistence of the primitive meninges. More frequently intracranial lipomas are central and located in the midline especially in corpus callosum. We report the two cases of intracranial lipoma, one case was detected in cerebellum by antenatal sonography and the other one was detected in right temporal cistern by cranial sonography during the postnatal follow-up.
Cerebellum ; Corpus Callosum ; Follow-Up Studies ; Lipoma* ; Meninges

BACKGROUND: The purpose of this study was to find the factors associated with becoming obese children during the past 2 years in 6th grade children of elementary school and then to evaluate the high risk groups for childhood obesity. METHODS: The 738 children from May to June, 2001 in 6th grade of 5 elementary schools in Busan were the subjects of this study. The children's height and weight in 4th grade and 6th grade were obtained from school health records. We calculated the body mass index in 4th and 6th grades and classified into 3 weight groups (normal, at risk for obesity, and obese) according to the age and sex-specific BMI established by the Korean Academy of Pediatrics. If children's weight group in 4th grade was changed to heavier weight group in 6th grade, we defined it as increased group. Otherwise, we defined it as non-increased group. The association between the increase in weight group and parental and children's characteristics were analyzed by x2-test, x2-test for the trend, t-test, ANOVA and multiple logistic regression. RESULTS: Among the total, 3.3% of children with normal weight and 16.9% of children at the risk for obesity in 4th grade were transformed to increased group in 6th grade, respectively (P<0.001). Children who had excessive appetite (P<0.001), watched TV greater than or equal to 2 hours per day (P=0.004) or had an obese father (P=0.044) were more likely to become increased group. After adjusting for father's obesity, appetite and TV watching time in children, the odds ratio of transforming to increased group after 2 years in children at risk for obesity or in obese child in 4th grade was 2.5 (95% CI: 1.09~5.55) compared to children with normal weight. Children having excessive appetite were 3.2 times (95% CI: 1.42~7.01) more likely to become the increased group after adjusting for father's obesity, TV watching time and weight in 4th grade. Children watching TV greater than or equal to 2 hours/day was 2.8 times (95% CI: 1.27~6.18) more likely to become increased group after adjusting for father's obesity, appetite and weight in 4th grade. CONCLUSION: The risk of becoming obese was higher in children at risk for obesity or obese children in those with excessive appetite or those who have watched TV> or =2 hours/day for the past two years. These findings suggest promotion of educational plan to prevent childhood obesity.
Appetite ; Body Mass Index ; Busan* ; Child* ; Fathers ; Humans ; Logistic Models ; Obesity ; Odds Ratio ; Parents ; Pediatric Obesity ; Pediatrics ; Risk Factors ; School Health Services

BACKGROUND: There are limited data regarding smoking cessation treatment by physicians in Korea. Thus, we investigated the attitude to smoking cessation intervention and services among Korean physicians. METHODS: This survey was conducted in 987 participating physicians who had experiences in smoking cessation services. The subjective difficulties of smoking cessation services and its causes and the presumptive reasons for failure of smoking cessation among their patients were investigated using questionnaires. RESULTS: Overall smoking rate among Korean physicians who participated in this survey was 12.6%. Most participating physicians had a difficulty in smoking cessation services and its causes were high cost of medication for smoking cessation due to non-imbursement (50.7%) and the absence of a medical fee on smoking cessation services (34.8%). The high cost of medication for smoking cessation due to non-imbursement (29.5%) also ranked high in the presumptive reasons for failure of smoking cessation among their patients. CONCLUSION: The smoking rate of Korean physicians in this survey was lower than those of the general population. Most participating physicians had a difficulty in offering smoking cessation services. And the most common cause for the difficult was non-imbursement of their services and medication.
Fees, Medical ; Humans ; Korea ; Smoke ; Smoking ; Smoking Cessation ; Surveys and Questionnaires

No abstract available.
Leukemia*