OBJECTIVE: The objective of this study is to compare the effectiveness and safety in the labor induction between the high dose oxytocin method and the new low dose oxytocin method. STUDY DESIGN: Firstly, we selected 125 pregnant women hospitalized, having the indication of labor induction from March, 1995 to August, 1996. Of them, we selected 61 pregnant women tothem the high dose oxytocin method was used, as the control group, and in- creased the quantity of 2.5 mU/min every 20 minutes with the start dose of 2.5 mU/min to them. On the other hand, with the start dose of 1.25 mU/min, we increased the quantity of 1.25 mU/min every 20 minutes to the study group of low dose oxytocin method, 64 pregnant women. RESULTS: No statistical significance was found in the time from the effective uterine contraction to the delivery in the study group, in contrast to that of the control group to them the labor induction was conducted by using the high dose oxytocin. Maximum amount used to the high dose oxytocin was significantly more than that of the low dose oxytacin, but in the total given dose, there was no significant difference between two groups. Maxi- mum uterine contraction of the control group did not show any significant. difference from that of the study group, and there was also no significant difference in the frequency of generating the complications such as fetal distress. CONCLUSION: There was no difference in the labor.induction -to delivery time, and the complications of fetus, between the existing high dose oxytocin method and the new low dose oxytocin method. Therefore it is thought the low dose oxytocin method may reduce the possibility of a complieation compared with the high dose oxytocin method. However, it is considered this matter must be investigated further in the futrre.
Female ; Fetal Distress ; Fetus ; Hand ; Humans ; Oxytocin* ; Pregnant Women ; Uterine Contraction

PURPOSE: The purpose of this study was to provide a basis for non-humidified low flow oxygen by nasal cannula and to provide a guide for consistent care in nursing practice. METHODS: A methodological study on the development of guidelines with experts' opinions on collected items, framing PICO questions, evaluating and synthesizing texts which were searched with the key words (low flow oxygen, nasal cannula, humidification of oxygen, guideline) from web search engines. RESULTS: Of the 45 researched texts on the web, 9 texts relevant to the theme were synthesized and evaluated. All patients with humidified or non-humidified oxygen therapy reported that they had no discomfort. CONCLUSION: The results indicate that there are no tangible grounds for patients' perceived differences between the humidified and non-humidified oxygen under 4L/min supplied by nasal cannula. with oxygen. Therefore, non-humidification oxygen therapy is strongly advised when suppling under 4L/min oxygen by nasal cannula (recommended grade A).
Catheters ; Humans ; Oxygen

The 12th rib syndrome is a disease that causes pain between the upper abdomen and the lower chest. It is assumed that the impinging on the nerves between the ribs causes pain in the lower chest, upper abdomen, and flank. A 74-year-old female patient visited a pain clinic complaining of pain in her back, and left chest wall at a 7 on the 0-10 Numeric Rating scale (NRS). She had a lateral fixation at T12-L2, 6 years earlier. After the operation, she had multiple osteoporotic compression fractures. When the spine was bent, the patient complained about a sharp pain in the left mid-axillary line and radiating pain toward the abdomen. On physical examination, the 10th rib was not felt, and an image of the rib-cage confirmed that the left 10th rib was severed. When applying pressure from the legs to the 9th rib of the patient, pain was reproduced. Therefore, the patient was diagnosed with 9th rib syndrome, and ultrasound-guided 9th and 10th intercostal nerve blocks were performed around the tips of the severed 10th rib. In addition, local anesthetics with triamcinolone were administered into the muscles beneath the 9th rib at the point of the greatest tenderness. The patient's pain was reduced to NRS 2 point. In this case, it is suspected that the patient had a partial resection of the left 10th rib in the past, and subsequent compression fractures at T8 and T9 led to the deformation of the rib cage, causing the tip of the remaining 10th rib to impinge on the 9th intercostal nerves, causing pain.
Abdomen ; Abdominal Pain ; Aged ; Anesthetics, Local ; Female ; Fractures, Compression ; Humans ; Intercostal Nerves ; Leg ; Muscles ; Neuralgia ; Pain Clinics ; Physical Examination ; Ribs* ; Spine ; Thoracic Wall ; Thorax ; Triamcinolone

OBJECTIVES: The main purpose of this study was to investigate relationship between cumulative trauma disorders(CTDs) and the types of workstation and chair in workers with repetitive motion tasks. METHODS: The study subjects were 77 repetitive motion tasks workers at small manufacturing industries in Seoul and Gyung-gi district area. A questionnaire was used to obtain about health practice for prevention and prevalence of CTDs by worker. The type of Workstations and chairs in workers were measured and analyzed with prevalence of CTDs by logistic regression. RESULTS: Eighty-six percent of workers recognized that work posture was related to workstation and chair. Most employers and employees didn't follow the work practice guidelines for workers with repetitive motion tasks. The prevalence of CTDs was 64% by questionnaire. The prevalence of pain in shoulder, neck, back, and arm were 38%, 15%, 6%, and 5%, respectively, and the pain started after working an average duration of 16.5 months. The CTDs symptoms were significantly related to thickness of workstation, height of workstation, length of knee depth under workstation, height of back rest, height of seat pan, depth of sitting surface, width of sitting surface, and length from workstation surface edge to shoulder. By multiple regression analysis of each risk factor, prevalence of CTDs was highly correlated with height of back rest, height of seat pan, and depth of sitting surface. CONCLUSIONS: This study suggests that workstations should be made adjustable for height and chairs should be equipped with seat pan height control, enough sitting surface for depth and width, back rest height and angle control. The workers should use the right working postures, exercise for health, occupational health education, and rest breaks and the manager of company should be educated for the preventing of CTDs.
Arm ; Cumulative Trauma Disorders* ; Health Education ; Knee ; Logistic Models ; Neck ; Occupational Health ; Posture ; Prevalence ; Questionnaires ; Risk Factors ; Seoul ; Shoulder

Perfusion scintigraphy has proved to be an essential part for the diagnosis of pulmonary thromboembolism. The wedge shaped perfusion defect extending to lung base is a highly probable finding of pulmonary embolism. Occasionally, great perfusion defects could be presented as a false positive finding under the circumstance of nonthromboembolic origin, such as neoplastic compression or invasion of pulmonary artery. We report an unusual case of massive perfusion defect resulting from pulmonary arterial compression by bronchogenic carcinoma. A 71-year-old man visited our hospital because of productive cough and was diagnosed as bronchogenic carcinoma. The perfusion scintigraphy showed unilateral total defect of lung, not accompanied by any clinical evidence of thromboembolism. A contrast enhanced computed tomogram showed heterogeneous mass shadow in left hilum, abutting to the descending aorta and compressing left main pulmonary artery. These findings suggested a nonembolic mechanism of perfusion defects which were produced by the neoplastic compression of pulmonary artery.
Aged ; Aorta, Thoracic ; Carcinoma, Bronchogenic* ; Cough ; Diagnosis ; Humans ; Lung* ; Perfusion Imaging ; Perfusion* ; Pulmonary Artery ; Pulmonary Embolism ; Thromboembolism

BACKGROUND: Pleural effusion is a common disease in clinical practice but its effect on pulmonary function and altered pulmonary mechanics after removal of effusion are not still largely understood. Previous studies have shown that there is little or a relatively small improvement in pulmonary function and arterial blood oxygenation after therapeutic thoracentesis. The present study was designed to assess the effect on pulmonary function of pleural effusion and to test whether there was a significant improvement in pulmonary function and arterial oxygenation after thoracentesis and to observe long term effect after thoracentesis. METHOD: We examined flow-volume curve, body box and arterial blood gas analysis according to severity of effusion, present symptom, and symptom duration. Then, we measured changes of pulmonary function after thoracentesis and observed longterm effect after thoracentesis. RESULT: 1) Pleural effusion cause restrictive pulmonary insufficiency. Not only functional impairment of small airway but also large airway is provoked. 2) MMFR, FEV1, Raw, PO2 are earlier improved than FVC and TLC after thoracentesis and patients without complication have mild restrictive pulmonary insufficiency after longterm observation 3) FVC, FEV1, & TLC are similarly restricted as severity of pleural effusion and PO2 is relatively decreased. 4) Cases with symptom duration 1 week or less and cases with dyspnea have more severe pulmonary insufficiency than others. 5) The flow volume curves show a relatively greater improvement in flow rates at large lung volumes than small airway. 6) Significant relationship is shown between first thoracentesis amount and changes of FEV1, FVC, TLC. CONCUSION: Pleural effusion cause restrictive pulmonary insufficiency and not only functional impairment of small airway impairment but also large airway is provoked. Then, Pulmonary function is progressively improved after thoracentesis and remained mild restrictive pulmonary insufficiency after recovery
Blood Gas Analysis ; Dyspnea ; Humans ; Lung ; Maximal Midexpiratory Flow Rate ; Mechanics ; Oxygen ; Pleural Effusion* ; Tuberculosis, Pleural*

Although discal cysts are a rare cause of low back pain and radiculopathy. Currently, surgical excision is usually the first-line treatment for discal cysts. However, alternative treatment methods have been suggested, as in some cases symptoms have improved with interventional therapies. A 27-year-old man presented with an acute onset of severe pain, and was found to have a discal cyst after an open discectomy. The patient underwent cyst aspiration and steroid injection through the facet joint under C-arm guidance. After the procedure, the patient's pain improved to NRS 0-1. On outpatient physical examination 1 week, and 1 and 3 months later, no abnormal neurological symptoms were present, and pain did not persist; thus, follow-up observation was terminated. When a discal cyst is diagnosed, it is more appropriate to consider interventional management instead of surgery as a first-line treatment, while planning for surgical resection if the symptoms do not improve or accompanying neurologic deficits progress.
Adult ; Diskectomy ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Low Back Pain ; Neurologic Manifestations ; Outpatients ; Physical Examination ; Radiculopathy ; Zygapophyseal Joint

BACKGROUND: As the number of elder patients grows, spinal anesthesia for such patients are increasing significantly. Any effort is needed to use the least anesthetic drug for maintaining the anesthesia while avoiding hazards of cardio-pulmonary complications. METHODS: American Society of Anesthesiologists physical status classification I and II, Forty five elderly patients (> or = 60 years) who received transurethral resection of the prostate or transurethral resection of the bladder tumor were allocated randomly into three treatment groups. The DMT 0.5 group was designed as with dexmedetomidine 0.5 microg/kg while the DMT 1.0 group has a 1 microg/kg intravenous injection over 10 min before anesthetic induction. The Control group was designed to get a normal saline. Each group was compared regarding the maximum sensory block level, extension of anesthesia, degree of motor block, level of sedation, VAS score and complications. RESULTS: There were no significant differences among the 3 treatment groups regarding the maximum level of sensory block and motor block. However, the duration of sensory block was significantly longer in DMT 1.0 group than in the control group (P = 0.045). Both DMT 1.0 group (median = 3, range = 2-6) and DMT 0.5 group (median = 3, range = 1-6) showed a mean value of 3-4 Ramsay sedation score, which resulted in more excessive sedation and significantly greater incidence of bradycardia compared to the control group. No complications such as hypotension, nausea, tremor, and hypoxia were found during this investigation. CONCLUSIONS: In elder patients, the DMT 1.0 group is effective in duration of sensory block and is superior in the aspect of prolonged duration of sensory block compared to the DMT 0.5 group.
Aged* ; Anesthesia ; Anesthesia, Spinal* ; Anoxia ; Appointments and Schedules* ; Bradycardia ; Classification ; Dexmedetomidine* ; Humans ; Hypotension ; Incidence ; Injections, Intravenous ; Nausea ; Prostate ; Tremor ; Urinary Bladder Neoplasms

PURPOSE: Medical students experience various stresses that arise in a special environment. However, there is no specific stress scale for medical students with regard to their environment in Korea. Therefore, in this study, we developed and confirmed the validity of a stress scale for medical students in Korea. METHODS: A draft version of the scale was developed on the basis of open-ended questionnaires from 97 medical students. The validity of the content of this scale was evaluated by three medical educationists. The scale was administered to 435 third and fourth grade medical students as the main survey. For our data, we performed an exploratory factor analysis and confirmatory factor analysis. We used Cronbach alpha index to determine internal consistency. RESULTS: Six factors with 40 items were extracted through the exploratory factor analysis: academic stress (9 items); clerkship stress (11 items); interpersonal stress (7 items); career stress (8 items); health-related stress (3 items); and financial stress (2 items). These factors showed a statistically significant correlation. The confirmatory factor analysis demonstrated a favorable RMSEA (0.053) and reasonable fit (CFI=0.847, TLI=0.833). Cronbach alpha values of the six factors ranged from 0.63 to 0.85. CONCLUSION: The medical student stress scale had a good model fit. It is a valid and reliable instrument in identifying stress in medical students and can be used in future studies. Also, the scale is expected to provide individual stress profiles for students to help them manage stress more effectively.
Factor Analysis, Statistical ; Humans ; Korea ; Students, Medical* ; Surveys and Questionnaires

We report a non-obese patient suffering from spastic gait and right leg paresis caused by thoracic spinal cord compression secondary to spinal epidural lipomatosis. Although spinal epidural lipomatosis is most often associated with the administration of exogenous steroid or endogenous Cushing syndrome, obesity also has been reported as a possible cause. However, idiopathic(non-glucocorticoid induced) spinal epidural lipomatosis in non-obese healthy man is an extremely rare disease and dose not have any good explanation for the abnormal fat deposition in spinal epidural space. We recently experienced a patient with idiopathic thoracic epidural lipomatosis in whom MRI and histopathology established the specific diagnosis. With a case report, brief review of the disease including clinical feature, diagnostic procedure and therapeutic considerations is described.
Cushing Syndrome ; Diagnosis ; Epidural Space ; Gait Disorders, Neurologic ; Humans ; Leg ; Lipomatosis* ; Magnetic Resonance Imaging ; Obesity ; Paresis ; Rare Diseases ; Spinal Cord Compression