PURPOSE: This quasi-experimental study was done to develop image-use medication education for older inpatients and to evaluate the effects on their knowledge, self-efficacy, and misuse of medication.
Aged ; Chronic Disease ; Education ; Humans ; Inpatients ; Non-Randomized Controlled Trials as Topic ; Patient Education as Topic

PURPOSE: Clinically, bladder outlet obstruction (BOO) causes not only obstructive symptoms but also overactive bladder symptoms which partially result from the increase of electrical coupling in the bladder. This study was performed to determine the effect of angiotensin converting enzyme (ACE) inhibitor on connexin (Cx) expression in overactive bladder caused by BOO in a rat model. MATERIALS AND METHODS: Fifty Sprague-Dawley rats were used for this study and divided into control (10 rats) and experimental (40 rats) groups. Partial obstruction was induced in the experimental group which was divided into two subgroups of 20 rats each: one group administered with ACE inhibitor (ACE inhibitor treated group) and the other without administration (obstruction group). Cystometrograms (CMG) were performed 2 weeks after BOO. The bladders of each group were dissected out and underwent staining for Cx26 and Cx43. RESULTS: On CMG, there was a significant decrease in contraction interval of the obstructive group compared with the control group. The ACE inhibitor treated group showed an increase in contraction interval compared with the obstruction group but a decrease in contraction interval compared with the control group (p<0.05). On immunohistochemical staining, Cx26 was localized in the mucosa and Cx43 in the mucosa and muscle layer. The staining intensity of Cx26 and Cx43 was increased in the obstructive group compared with the control group, but decreased in the ACE inhibitor treated group compared with the obstruction group. CONCLUSIONS: ACE inhibitor decreased the expression of Cx and relieved the overactive bladder symptom. Therefore, ACE inhibitor could be used as alternative agent for the treatment of overactive bladder associated with BOO.
Angiotensin-Converting Enzyme Inhibitors ; Animals ; Connexin 43 ; Connexins ; Models, Animal ; Mucous Membrane ; Peptidyl-Dipeptidase A ; Rats* ; Rats, Sprague-Dawley ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urinary Bladder, Overactive

Granular cell tumors are uncommon soft tissue tumors which arise as solitary or multiple masses. Lesionscommonly arise in the head, neck, and chest wall, but can occur in any part of the body. To our knowledge,periurethral granular cell tumor has not been previously reported. We report one such case.
Granular Cell Tumor* ; Head ; Neck ; Thoracic Wall

PURPOSE: To investigate the etiology, pathologic finding, main symptom, and ideal age for operative correction, trigger thumb in children, without any residual symptom and complications. MATERIALS AND METHODS: 162 children (199 thumbs), who underwent operative treatment, formed the basis of this study. We investigate the main symptom, trauma history, other medical history, age of operation, relief of symptoms and complications after surgery. Two specimens were examined histolgically. RESULTS: Only four (2.5%) thumbs demonstrated triggering at birth. All patients had flexion contracture of the interphalangeal joint of the thumb. There were nodules in 50 thumbs (25.3%) and triggering in 38 thumbs (19.2%). The average age at the time of surgery was forty months. All patients, had complete resolution of triggering after surgery and at the time of follow-up examinations, except for one patient who demonstrated a prominent wound scar. In the histological analysis, proliferation of fibroblasts and dense collagen material without inflammation and degeneration were characteristic findings. CONCLUSION: Trigger thumb in children is a developmental condition caused by A1 pulley hypertrophy. The main symptom was flexion contracture. Therefore the term, developmental flexion contracture of the thumb, "rather than congenital trigger thumb, " is more appropriate. Surgical intervention is inexpensive, simple, safe and successful in preschool-aged children with persistent symptoms.
Child ; Cicatrix ; Collagen ; Contracture* ; Fibroblasts ; Follow-Up Studies ; Humans ; Hypertrophy ; Inflammation ; Joints ; Parturition ; Thumb* ; Trigger Finger Disorder* ; Wounds and Injuries

PURPOSE: To compare the efficacy of breathhold and non-breathhold sequences in the detection of hepatocellular carcinoma (HCC) in cirrhotic patients using superparamagnetic iron oxide (SPIO)-enhanced MR imaging, and to determine the optimal sequence combination. MATERIALS AND METHODS: By means of unenhanced and iron-oxide-enhanced MRI, 29 patients with 49 nodular HCCs were evaluated for the presence of HCC nodules. Twenty-one were male and eight were female, and their ages ranged from 38 to 71 (mean, 56) years. Eight different MR sequences were used, including four non-breath-hold sequences and four breath-hold, and images were obtained before and after the administration of S-PIO particles. Non-breath-hold sequences included T2-, proton density-weighted SE, and TSE imaging, while breath-hold sequences comprised T1-weighted fast low-angle shot (T1wFLASH), half-Fourier acquisition single shot turbo spine echo (HASTE), T2-weighted fast imaging with steady-state free precession (T2*wFISP) and T2-weighted breath-hold TSE (T2wBHTSE). Image analysis involved both quantitative and qualitative analysis. The quantitative parameters calculated were signal-to-noise (S/N) ratios for livers and tumors, contrast to noise (C/N) ratios for tumors seen on precontrast and postcontrast images, and percentage of signal intensity loss (P-SIL) after SPIO injection. Images were analysed qualitatively in terms of image artifacts and lesion conspicuity, and prior to calculating sensitivity, the numbers of lesions detected using various pulse sequences were counted. RESULTS: SPIO had a marked effect on liver S/N ratio but a minimal effect on tumor S/N ratio. PSIL was best in T2*wFISP images, while T2wSE images showed the second-best results (p< 0.05). Tumor-to-liver C/N values were also highest with T2*wFISP, while T2wTSE and HASTE images were next. Qualitative study showed that non-breath hold images and FISP were better than breath hold images in terms of lesion conspicuity. The latter, however, were much better than non-breath-hold images with regard to image artifacts (p <0 . 0 5 ) . Sensitivity after the injection of contrast material increased in every image sequence except T1wFLASH, and,in particular, postcontrast FISP and T2wTSE showed the best results (p> 0.05). CONCLUSION: SPIO-enhanced MR imaging effectively detected hepatocellular carcinoma in cirrhotic livers. In terms of lesion detection and improvement of the lesion to liver C/N ratio, the FISP sequence was at least as good as non-breath-hold sequences, but if the T2 suppression effect of SPIO is to be obtained, other breath-hold sequences are not appropriate. To help lesion characterization, we suggest that T1w-FLASH and non-breath- hold T2w-TSE imaging are added to the optimal SPIO-enhanced MR imaging sequence.
Artifacts ; Carcinoma, Hepatocellular ; Female ; Humans ; Iron ; Liver ; Magnetic Resonance Imaging* ; Male ; Noise ; Protons ; Spine

OBJECTIVE: To determine if a combination of ferucarbotran-enhanced T2*weighted-gradient echo (T2*W-GRE) and T2-weighted turbo spin echo (T2W-TSE) images in gadolinium- and ferucarbotran-enhanced MRI has additive efficacy compared to each image alone for detecting small (< or = 2.0 cm) hepatocellular carcinoma (HCC) lesions in a group of cirrhotic patients and metastases in a group of non-cirrhotic patients. MATERIALS AND METHODS: Two readers retrospectively analyzed gadolinium- and ferucarbotran-enhanced T2*W-GRE, T2W-TSE, and combined T2*W-GRE/T2W-TSE images of 119 patients with 157 HCCs and 32 patients with 98 metastases. The diagnostic accuracy and sensitivity for each image set and the combined set were evaluated using the alternative-free response receiver operating characteristic method. RESULTS: The mean area under the curve value of the combined set (0.966) tended to be better than that for each individual image set (T2W-TSE [0.910], T2*W-GRE [0.892]). Sensitivities in the combined set were higher than those in each individual image set for detecting HCC (mean, 93.0% versus 81.6% and 86.7%, respectively, p < 0.01). Sensitivities in the combined set and the T2W-TSE set were the same for detecting metastases, and both were higher than the sensitivity seen in the T2*W-GRE set (mean, 97.5% versus 85.2 %, p < 0.01). CONCLUSION: Combining ferucarbotran-enhanced T2*W-GRE and T2W-TSE has additive efficacy for detecting HCC in cirrhotic patients, but T2W-TSE is preferred for detecting metastases in non-cirrhotic patients.
Adult ; Aged ; Carcinoma, Hepatocellular/*diagnosis ; Contrast Media/*administration & dosage ; Female ; Gadolinium DTPA/*diagnostic use ; Humans ; Iron/*diagnostic use ; Liver Neoplasms/*diagnosis/secondary ; *Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Observer Variation ; Oxides/*diagnostic use ; Predictive Value of Tests ; Sensitivity and Specificity

We describe a case of poorly differentiated gastric neuroendocrine carcinoma presenting as a wandering exophytic mass. CT imaging revealed a 14.5x10.0x8.0 cm, lobulated, solid mass with a multifocal necrotic portion at the right of the peritoneal cavity. It was attached to the antrum of the stomach by a broad stalk, and shown by MR imaging to be well-defined, lobulated and solid, with a multifocal necrotic portion, and at the left of the peritoneal cavity. Isointensity was apparent at T1-weighted imaging, and slightly hyperintensity at T2-weighted imaging, and after gadolinium injection, enhancement was stronger than at precontrast imaging.
Carcinoma, Neuroendocrine* ; Gadolinium ; Magnetic Resonance Imaging ; Peritoneal Cavity ; Stomach

17 cases of acute myocardial infarction with no or insignificant narrowing of major coronary arteries on angiogram and without any-other types of heart disease were found in a series of 133 consecutively studied patients with acute myocardial infarction(12,7%). There were no differences in risk factors between groups. Although the infarction site were similar in both groups, the patients with normal coronary arteries had fewer complications during hospitalization(p<0.05) and lesser ST segment change during the exercise test before discharge(p<0.05). In the hemodynamic fingings, cardiac index, left ventricualr and diastolic pressure and resional wall motion were similar in both groups of the patients, but ejection fraction was higher(p<0.05) in the patients with the normal coronary arteries. In conclusion, it could be predicted that the acute myocardial infarction with the normal coronary arteries would have the better prognosis. And a transient coronary occlusion, as the most likely pathogenic mechanism of the acute mtocardial infarction with normal coronary arteries, might be studied in the aspect of the thrombosis following lysis, the coronary artery spasm and the platelet aggregation.
Angiography* ; Blood Pressure ; Coronary Occlusion ; Coronary Vessels ; Exercise Test ; Heart Diseases ; Hemodynamics ; Humans ; Infarction ; Myocardial Infarction* ; Platelet Aggregation ; Prognosis ; Risk Factors ; Spasm ; Thrombosis

Synovial chondromatosis is a rare lesion in the wrist, but some cases in the distal radioulnar joint have been reported and previous case reports emphasize joint calcifications, shown on preoperative plain radiographs. We report an extremely uncommon case of synovial chondromatosis in the pisotriquetral joint, in which radiographs and magnetic resonance imaging did not demonstrate apparent calcified bodies. In our case, for the accurate diagnosis and treatment, surgical exploration of the joint and synovectomy with removal of loose bodies was performed.
*Chondromatosis, Synovial/diagnosis/physiopathology/surgery ; Female ; Humans ; Middle Aged ; *Wrist Joint/physiopathology/surgery

OBJECTIVE: To investigate whether the findings of wrist magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) is representative of their disease activity. METHODS: MRI and plain radiographs were performed on the wrists of 15 patients with RA. Four MRI techniques were used; T1 weighted spin echo image (T2WI), chemical fat suppression T2 weighted image (FS-T2WI) and Gadolinium-DTPA contrast enhanced T1 weighted image (CE-TIWI). Erosion scores used as radiologic index were calculated from total counts of bone erosion in all coronal planes of wrist MRI and .plain radiographs. This erosion score was compared with the clinical indices (Ritchie index, grip strength, visual analogue pain scale) and laboratory indices (ESR, CRP, hemoglobin, immunoglobulins). RESULTS: MRI erosion score of the wrist in patients with RA significantly correlated with ESR and serum IgG level, but did not correlate with global clinical indices such as grip strength and Ritchie index. MRI was especially useful in early detection of erosive bone change. Special MR images such as fat suppres-sion and Gd-DTPA enhanced images were superior to plain radiographs and conventional MR images in detecting the erosive lesion of carpal bones. CONCLUSIONS: Wrist MRI is useful in early detection of erosive bone change and may be an important tool for the measurement of disease activity in RA. We prospect that it could be used to assess the progression of the disease and the response of drug therapy.
Arthritis, Rheumatoid ; Carpal Bones ; Drug Therapy ; Gadolinium DTPA ; Hand Strength ; Humans ; Immunoglobulin G ; Magnetic Resonance Imaging* ; Wrist*