PURPOSE: This study was conducted to determine the effects of a fall prevention program on knowledge, efficacy, and prevention behavior of falls among the low-income elderly. METHODS: This study used a nonequivalent control group pre and post test quasi-experimental research design. The study was conducted from August to October, 2008 with 20 subjects in the experimental group and 22 in the control group who were registered at the public health center of S District in D City. RESULTS: Hypothesis 1 "The experimental group that participated in the fall prevention program will show a higher degree of knowledge about falls than the control group" was supported. Hypothesis 2 "The experimental group will have a higher degree of self-efficacy of falls than the control group" was not supported. Hypothesis 3 "The experimental group will report fall prevention behavior more frequently than the control group" was supported. CONCLUSION: It was verified that the fall prevention program in this study was an effective intervention to improve knowledge about falls and fall prevention behaviors among the low-income elderly. The results can be used as part of an intervention to prevent falls for the vulnerable elderly such as the low-income elderly.
Accidental Falls ; Aged* ; Humans ; Public Health ; Research Design ; Self Efficacy

To make guideline to the diagnosis and treatment and of the intracranial nodular lesions, the authors made a clinical analysis on 81 pediatric patients who had showed nodular lesions on brain CT scan at Severance Hospital from Mar. 1979 to Feb. 1989 and the results were summarized as follows. 1) The peak incidence of intracranial nodular lesions was found in the 2nd decade(61.7%). There was no sexual difference. 2) The most common clinical symptom was seizure(92.6%) and the predilection site was parietal area. The nodular enhancing type on brain CT scan showed not only the most common type but also the most favorable clinical course. 3) As the etiology of the intracranial nodular lesions, tuberculosis, paragonimiasis, cysticercosis, tumor(meningioma), and aspergillosis were confirmed or suspected, but tuberculosis was the most common. CSF routine examination, chest PA, PNS X-rays, skin test for paragonimiasis and tuberculosis, CSF ELISA test for cysticercosis and paragonimiasis should be routine as the diagnostic studies. 4) We made treatment principle for intracranial nodular lesions. In cases that initial brain CT scan show low density or calcified density without contrast enhancement, we treat those patients with anticonvulsants and steroid with regular check-up. If the lesion increases in size or new enhancement develops on follow up CTY scan, medications for the suspected etiology should be added. In cases that initial brain CT scan show enhancing lesions, treatment is started with anticonvulsants and medications for the etiology with regular check up. If the lesion increase in size on follow up CT scan or seizure is uncontrolled. Surgery should be considered.
Anticonvulsants ; Aspergillosis ; Brain* ; Child* ; Cysticercosis ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Follow-Up Studies ; Humans ; Incidence ; Meningioma ; Paragonimiasis ; Rabeprazole ; Seizures ; Skin Tests ; Thorax ; Tomography, X-Ray Computed* ; Tuberculosis

BACKGROUND: Depression and anxiety are common psychiatric symptoms in patients with epilepsy, exerting a profound negative effect on health-related quality of life. Several issues, however, pertaining to their association with psychosocial, seizure-related and medication factors, remain controversial. In the present study we have investigated the association of depression and anxiety with various demographic and seizure-related variables in patients with newly-diagnosed and chronic epilepsy. METHODS: We investigated 80 patients with epilepsy (46.3% males, mean age 36.1+/-11.4 years, range 18~64; mean disease duration, 13.4+/-12.2 years). Depression and anxiety were assessed in the interictal state with the Beck Depression Inventory, 21-item version (BDI-21) and the state and trait subscales of the State-Trait Anxiety Inventory (STAI-S and STAI-T), respectively. The association of depression and anxiety with various variables was investigated using univariate analyses and multiple linear regression analyses. RESULTS: Duration of epilepsy, the number of side effects and the number of GABAergic anti-epileptic drugs were correlated with depression, together accounting for 25.1% of the variation of the BDI-21. The STAI-S index was significantly associated with occupation status and the number of GABAergic anti-epileptic drugs accounting for 27.4% of the variation of the STAI-S. Finally, the number of side effects was correlated with trait anxiety. CONCLUSIONS: Our study shows that the duration of epilepsy, occupation status, GABAergic anti-epileptic drugs and the number of side effects are risk factors for the development of depression and/or anxiety.
Accounting ; Anxiety ; Depression ; Epilepsy ; Humans ; Linear Models ; Male ; Occupations ; Quality of Life ; Risk Factors

No abstract available.
Cerebral Infarction* ; Craniocerebral Trauma* ; Head* ; Humans ; Oxygen*

"We retrospectively reviewed the results of 1,850 fine needle aspiration cytology (FNAC) of thyroid nodules performed from 1990 to 1991 in the Department of Pathology, Seoul National University Hospital. Among 1,528 cases and 322 cases aspirated by clinicians and a pathologist, 465 cases (30.4%) and 13 cases (4.0%) of the aspirates were inadequate, respectively. In 227 cases, correlation of the FNAC diagnosis and histologic diagnosis was done. Excluding the inadequate cases, the sensitivity for the detection of neoplasm (malignancy together with follicular adenoma) was 86.4% and the specificity was 70.7%. The overall diagnostic accuracy was 79.0%. There were 16 false-positive cases (7.0%), and 19 false-negative cases (8.4%). The predictive value of each cytologic diagnosis was 92% in papillary carcinoma, and 100% in Hashimoto's thyroiditis. The expectancy of malignancy was 52.8% in ""suspicious malignancy"" and 26.7% in ""atypical lesion""."
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Pathology ; Retrospective Studies ; Sensitivity and Specificity ; Seoul ; Thyroid Gland ; Thyroid Nodule ; Thyroiditis

The authors analyzed 38 consecutive cases with an occipital arteriovenous malformation(AVM) in regard to visual field defect. The incidence of occipital AVM was 10.4% among 367 patients with a cerebral AVM treated between 1975 and 1994 in our institute. Bleeding rate of occipital AVM in this series was 86.8%(EE cases) and it was significantly higher than that of AVM in other locations. Of 38cases, 15 patients(39.5%) had a visual field defect on admission and all of them were accompanied by intracerebral hematomas caused by the rupture of AVMs. The presence of visual field defect did not correlate with angioarchitecture in reference to pattern of nidus, feeding artery, and draining vein. Of 15 patients with visual field defect. 10 patients showed homonymous hemianopsia and five patients, homonymous quadrantanopsia. The size and location of intracerebral hematoma correlated well with hemispheric approach : 11, parietooccipital approach : 10, with six preoperative embolization and 1 postoperative gamma knife surgery. Fifteen patients underwent gamma knife surgery with five preoperative embolization. One patient underwent embolization only. The results of treatment were as follows : There were no mortality and morbidity except for visual field defect. We confirmed complete resection or obliteration of malformed vessels in 25 patients and reduction of the nidus size in eight patients. Five patients were not followed. After gamma knife surgery, two patients showed rebleeding during the follow up period. Among 23 patients who had no visual field defect before treatment, three patients showed visual field defect after treatment(one after microsurgical resection using occipital interhemispheric approach, two after preoperative embolization). In 15 patients with visual field defect before treatment, four patients showed improvement in their visual field defect after treatment(three after microsurgical resection using occipital interhemispheric approach, one after gamma knife surgery). The parietooccipital approach did not change the status of visual field in any of the ten parients. In occipital AVM, visual field defect was the most srious morbidity. Ruptured occipital AVM had a higher incidence of hemorrhage causing a visual field defect and had a higher indication of direct surgical approach than AVM of other location. In planning surgery of occipital AVM, one has to count microsurgical anatomy based on the visual pathway as well as clinical findings such as the angioarchitecture, location of intracerebral hematoma, and preopeative visual field.
Arteries ; Arteriovenous Malformations* ; Follow-Up Studies ; Hematoma ; Hemianopsia ; Hemorrhage ; Humans ; Incidence ; Mortality ; Occipital Lobe ; Rupture ; Veins ; Visual Fields* ; Visual Pathways

To formulate treatment strategies for poor-grade patients after aneurysmal subarachnoid hemorrhage(SAH), medical records were analyzed for 166 patients who were in Hunt and Hess grade IV or V among 588 consecutive aneurysmal SAH patients admitted during the past 5 years. Causes for unfavorable outcome(poor or dead) in these 166 patients were carefully evaluated to improve the management outcome. Overall management results were favorable(good or fair) in 71(42.8%), and unfavorable in 95(78 dead, 17 poor). Direct clipping was performed in 90 patients, and the surgical results were favorable in 69(76.7%) and unfavorable in 21(23.3%). Surgery was not performed in 76 patients because of moribund state on arrival in 41, neurological deterioration due to rebleeding in 15, massive brain swelling in seven, serious medical illness in five, severe delayed ischemic deficit in one, and massive cerebral infarction following angiography in one, and refused surgery in six. Seven patients survived from non-surgery group(2 fair, 5 poor). Direct effects of aneurysm rupture(34.8%) and early rebleeding(34.8%) were the causes of unfavorable outcome in grade IV patients, while it was direct effect of aneurysm rupture(91.8%) in grade V patients. It is suggested that since rebleeding is the only preventable factor of unfavorable outcome, urgent management seems necessary to prevent rebleeding, especially for grade IV patients. Grade IV patients should be treated aggressively with direct clipping for non-complex aneurysms or for patients with hematoma, and with coil embolization for complex aneurysms without hematoma.
Aneurysm ; Angiography ; Brain Edema ; Cerebral Infarction ; Embolization, Therapeutic ; Hematoma ; Humans ; Intracranial Aneurysm* ; Medical Records

We studied the intradiscal pressure in order to understand the biophysics of the lumbar intervertebral disk. We evaluated the relationship between disk morphology and intradiscal pressure in 90 lumbar intervertebral disks of 64 patients. The intrinsic intradiscal pressure in the ruptured disks was much lower than that in the normal or bulging disk, but intrinsic intradiscal pressure alone did not correlate in a statistically significant way to the absence, or presence and/or type of disk herniation. The elastance of normal disks was statistically significantly higher than that of the protruded disk(p<0.05) ; however, the elastance of lumbar disk was not affected by type of disk protrusion. Factors affecting disk elastance were the degeneration and the integrity of the annulus fibrosus and the posterior longitudinal ligament. The authors experienced no complication during the procedure. The measurement of the intradiscal pressure to evaluated the biophysical function of lumbar intervertebral disks is only a simple and risk-free procedure. Also it is suggested that patients with bulging disks of high elastance may be treated by reducing intradiscal pressure with percutaneous procedures such as chemonucleolysis, and automated discectomy using Nucleotome.
Biophysics ; Diskectomy ; Humans ; Intervertebral Disc Chemolysis ; Intervertebral Disc* ; Longitudinal Ligaments

Temporary interruption of cerebral blood flow is an effective maneuver to prevent and/or to control excessive bleeding during cerebrovascular procedures. Despite the benefits of temporary arterial occlusion, there is still a risk of ischemic neuronal damage associated with this procedure. It remains controversial whether it is safer to use brief periods of interrupted temporary occlusion separated by reperfusion periods or single continuous temporary occlusion. Two injury mechanisms, disturbed calcium homeostasis and lipid peroxidation, participate in the neuronal damage caused by temporary occlusion but their contributions to the two different types of temporary occlusion are presumed to be different in some degrees. The authors investigated the effect of nimodipine(calcium channel blocker) and U74389G(21-aminosteroid, lipid peroxidation inhibitor) on the focal cerebral blood flow and the size of cerebral infarction in two different types of temporary occlusion(a single, one hour continuous occlusion or three 20-minute repeated occlusions during a 40-minute interval) using the cat focal ischemic model. Results are as follows: 1) Intermittent, repeated occlusion caused lesser cerebral infarction than single continuous occlusion. 2) Postischemic hypoperfusion was more severe in intermittent repeated occlusion group but it was not statistically significant. 3) Nimodipine and U74389G reduced the size of cerebral infarction caused by two types of temporary occlusions significantly but there was no difference between two treatments. 4) U74389G ameliorated the postischemic hypoperfusion caused by both types of temporary occlusion but nimodipine did not. 5) Nimodipine protected caudato-putamen from the ischemic injury more effectively than U74389G. On the basis of the above findings, both types of injury mechanism(disturbed calcium homeostasis and lipid peroxidation) seemed to contribute to the two types of temporary occlusion(single continuous and intermittent repeated), in the similar extent. It is presumed that nimodipine has a preventive effect during the ischemic period and U74389G has a protective effect during reperfusion period.
Animals ; Calcium ; Cats* ; Cerebral Infarction* ; Hemorrhage ; Homeostasis ; Lipid Peroxidation ; Neurons ; Nimodipine* ; Reperfusion

The authors analyzed 197 consecutive cases of ruptured aneurysm surgery and investigated the incidence of postoperative subdural fluid(SDF) collection according to patient's age, amount of subarachnoid hemorrhage, preoperative ventricular dilatation, and combined surgical procedures such as ventricular or spinal fluid drainage, and opening of the lamina terminalis and/or the Lilliequist's membrane. We also evaluated the postoperative course for each patient with regard to the development of hydrocephalus. The results were as follows; incidence of SDF collection after aneurysm surgery was 20.8% and it correlated well with patient's age, initial CT grade, preoperative ventricular dilatation and opening of major cerebrospinal fluid(CSF) space. Especially, in patients with a preoperative dilated ventricle that had not been corrected(with preoperative shunting procedure), the incidence of postoperative SDF collection was very high(53.8%). In contrast, postoperative SDF collection didn't develop in six patients whose ventricle had dilated and it had been corrected with preoperative shunting procedures(two cases) or intraoperative external ventricular drainage followed by internalization(four cases). Patients wth postoperative SDF collection had a higher incidence of hydrocephalus than the other group. Hydrocephalus developed more frequently in the large SDF collection group than in the small one. On the basis of the above findings, we presumed postoperative SDF collection to be a manifestation of disturbed CSF circulation in ruptured aneurysm surgery. Because of the risk of rebleeding after preoperative shunting procedures, intraoperative diversion of CSF followed by early internalization should be recommended for preventing the development of postoperative SDF collection in patients with disturbed CSF circulation. We also discussed possible mechanisms of the conversion of postoperative SDF into hydrocephalus in relation to disturbed CSF circulation.
Aneurysm ; Aneurysm, Ruptured* ; Cerebrospinal Fluid* ; Dilatation ; Drainage ; Humans ; Hydrocephalus ; Hypothalamus ; Incidence ; Membranes ; Subarachnoid Hemorrhage