OBJECTIVE: To compare the safety and efficacy of intravaginal misoprostol versus intracervical dinoprostone (prostaglandin E2 gel) for cervical ripening and labor induction. METHODS: 60 patients with indication for labor induction and unfavorable cervices were randomly assigned to receive either intravaginal misoprostol or intracervical dinoprostone. 50 microgram tablets of misoprostol were placed in the posterior vaginal fornix every 4 hours for a maximum of 3 doses or dinoprostone 0.5mg was placed into the endocervix every 6 hours for a maximum of 2doses. No more medication was given after either spontaneous rupture of membranes or beginning of active labor. RESULTS: Among 60 patients enrolled, 30 received misoprostol and 30 received dinoprostone. The average interval from start of induction to active labor was shorter in misoprostol group (6.5+/-3.2 hours) than in the dinoprostone group (10.7+/-7.3 hours) (p<0.05). Oxytocin augmentation of labor occurred more often in the dinoprostone group (36.7%) than in the misoprostol group (10.0%) (p<0.05). There was a higher prevalence of fetal distress (23.3% versus 3.3%) and tachysystole (16.6% versus 6.6%) in the misorprostol group than in the dinoprostone group(p<0.05). CONCLUSIONS: Vaginally administered misoprostol is an effective agent for cervical ripening and induction of labor. Furthermore, the cost of misoprostol ( 360/200microgram) is much less than that of dinoprostone ( 42,000/0.5mg). Cost benefits from administration of misoprostol are evident, especially in clinics under system of diagnosis-related group (DRG) : however when given at this dosage, it is associated with a higher prevalence of fetal distress and tachysystole than dinoprostone. Further studies to compare the safety of misoprostole to that of dinoprostone and to delineate an optimal dosing regimen for misoprostol are needed.
Cervical Ripening* ; Cost-Benefit Analysis ; Diagnosis-Related Groups ; Dinoprostone* ; Female ; Fetal Distress ; Humans ; Membranes ; Misoprostol* ; Oxytocin ; Pregnancy ; Prevalence ; Prospective Studies* ; Rupture, Spontaneous ; Tablets

PURPOSE: The purpose of this study was to identify the job of emergency room (ER) nurses working in small and medium sized hospitals and to explore factors affecting their job. METHODS: The survey data were collected between January 2014 and May 2014 and participants were 159 nurses working in Seoul, Kyunggi, Incheon, and Chungnam in hospitals of less than 500 beds. RESULTS: The score for nurses job was 2.12/4.0, and emergency treatment (1.87/4.0) followed basic nursing (3.51/4.0) and counseling (2.32/4.0). The nursing job was significantly different depending on the age, education level, position, resident doctor(emergency medicine specialty or other) and grade of ER (regional ER or local ER). In the multiple regression, education level (beta=.18), position (beta=.24), hospital size (beta=.20), and grade of ER (beta=.21) explained 17.0% of variance in ER nurses' job in small and medium sized hospitals. CONCLUSION: The findings indicate that ER nurses in vulnerable areas do more nursing practice including emergency treatment as well as the usual independent nursing practice. Accordingly, a systematic assignment of nursing professionals is needed to reduce loading of ER nurses in small and medium sized hospitals.
Chungcheongnam-do ; Counseling ; Education ; Emergencies* ; Emergency Service, Hospital* ; Emergency Treatment ; Gyeonggi-do ; Health Facility Size ; Incheon ; Nursing ; Seoul

No abstract available.
Head* ; Magnetic Resonance Imaging* ; Necrosis*

No abstract available.
Epithelium* ; Humans* ; Insulin*

A 18-month-old girl was seen because of an yellowish brown papular eruptions on the face, earlobes and neck of one year duration. A skin biopsy specimen revealed circumscribed cellular infiltrates composed of predorninantly pleornorphic histiocytes. Electron microscopy of biopsy material disclosed numerous worm like particles and coated vescles in limited area of the cell cytoplasm, consistent with the findinga described in benign cephalic histiocytosis. After six months of her first visit, the individual papules became flattened.
Biopsy ; Coated Vesicles ; Cytoplasm ; Female ; Histiocytes ; Histiocytosis* ; Humans ; Infant ; Microscopy, Electron ; Neck ; Skin

This review-article is aimed at shedding a light upon the nature of age-associated changes in the human skeletal system. When the anatomical, physiological and biochemical consequences of bone aging are considered together with the hardening, drying and the diminished repair capabilities of the elderly, it can be seen that fractures assume greater importance as a clinical problem in the geriatric population. Older people start out with a deficit of cortical bone, making them more fracture prone and once fractures occur, the necessary treatments (immobilization, use of casts, etc.) accelerate the rate of bone loss. In addition, aged individuals stand a higher risk for complications of the hospital and enforced bed rest that may ensue. The problems resulting from bone loss in the elderly may be partially alleviated by providing adequate health service support which should include consideration of the following points : 1. Age, sex and general health status ; 2. Habits and inclinations towards physical activities ; 3. Nutritional and endocrine background ; 4. Presence of any specific bone diseases, including osteoporosis, osteoarthritis, osteomalacia and ankylosis ; 5. Psychosocial adaptability and other behavioral elements.
Aged ; Aging ; Ankylosis ; Bed Rest ; Biology* ; Bone Diseases ; Health Services ; Humans* ; Motor Activity ; Osteoarthritis ; Osteomalacia ; Osteoporosis

Patients with human immunodeficiency virus (HIV) infection have a higher burden of seizures, but few studies have examined seizures in HIV-infected individuals in Korea. A retrospective study was conducted to determine the epidemiology and clinical characteristics of seizures in patients with HIV infection. Among a total of 1,141 patients, 34 (3%) had seizures or epilepsy; 4 of these individuals had epilepsy before HIV infection, and the others showed new-onset seizures. Most patients exhibited moderate (200 to 500, n = 13) or low (below 200, n = 16) CD4 counts. The most common seizure etiology was progressive multifocal leukoencephalopathy (n = 14), followed by other HIV-associated central nervous system (CNS) complications (n = 6). Imaging studies revealed brain lesions in 21 patients. A total of 9 patients experienced only one seizure during the follow-up period, and 25 patients experienced multiple seizures or status epilepticus (n = 2). Multiple seizures were more common in patients with brain etiologies (P = 0.019) or epileptiform discharges on EEG (P = 0.032). Most seizures were controlled without anticonvulsants (n = 12) or with a single anticonvulsant (n = 12). Among patients with HIV infection, seizures are significantly more prevalent than in the general population. Most seizures, with the exception of status epilepticus, have a benign clinical course and few complications.
Adult ; Aged ; Anticonvulsants/therapeutic use ; Causality ; Comorbidity ; Electroencephalography/*statistics & numerical data ; Female ; HIV Infections/diagnosis/*epidemiology ; Humans ; Incidence ; Longitudinal Studies ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Risk Factors ; Seizures/*diagnosis/*epidemiology/prevention & control ; Treatment Outcome

BACKGROUND: The dose-responses of neuromuscular blocking agents may be influenced by many factors including age and inhalation anesthetics. This study was designed to determine the dose-response relationships of a new, short-acting muscle relaxant, mivacurium during nitrous oxide-halothane or nitrous oxide-enflurane anesthesia in two age groups, infants and 1 to 6 years old preschool children. METHODS: Neuromuscular blockade was monitored by recording the accelerographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 seconds at 10-second intervals. To estimate dose-response relationships, 24 infants or children of two anesthetic subgroups for each age group received single bolus doses of 45~100 g/kg of mivacurium. The ED50 and ED95 were estimated from linear regression plots of log-dose vs probit of twitch depression. The lag time, onset time and maximal depression of twitch height for the selective medium dose were mesured. RESULTS: The ED50 and ED95 for the infants group were 38.2 and 53.3 g/kg during halothane anesthesia, and 29.8 and 48.6 g/kg during enflurane anesthesia, respectively. And, those for preschool children group were 49.4 and 90.7 g/kg during halothane anesthesia, and 32.3 and 81.4 g/kg during enflurane anesthesia, respectively. There was a parallelism of the dose-response curve between halothane and enflurane anesthesia in either age group. Also, there was statistically significant difference in the maximal twitch depression for the selective medium dose of mivacurium between halothane and enflurane anesthesia in either group. CONCLUSIONS: The potency of mivacurium during enflurane anesthesia is higher than that during halothane anesthesia in infants and preschool children, and during either inhalation anesthesia the dose of mivacurium is less required in infants than preschool children.
Anesthesia* ; Anesthesia, Inhalation ; Anesthetics, Inhalation ; Child ; Child, Preschool* ; Depression ; Enflurane* ; Halothane* ; Humans ; Infant* ; Linear Models ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Ulnar Nerve

PURPOSE: We studied enhanced method to view the vessels in the brain using Magnetic Resonance Angiography (MRA). Noticing that Maximum Intensity Projection (MIP) image is often used to evaluate the arteries of the neck and brain, we propose a new method for view brain vessels to stereo image in 3D space with more superior and more correct compared with conventional method. MATERIALS AND METHODS: We use 3T Siemens Tim Trio MRI scanner with 4 channel head coil and get a 3D MRA brain data by fixing volunteers head and radiating Phase Contrast pulse sequence. MRA brain data is 3D rotated according to the view angle of each eyes. Optimal view angle (projection angle) is determined by the distance between eye and center of the data. Newly acquired MRA data are projected along with the projection line and display only the highest values. Each left and right view MIP image is integrated through anaglyph imaging method and optimal stereoscopic MIP image is acquired. RESULTS: Result image shows that proposed method let enable to view MIP image at any direction of MRA data that is impossible to the conventional method. Moreover, considering disparity and distance from viewer to center of MRA data at spherical coordinates, we can get more realistic stereo image. In conclusion, we can get optimal stereoscopic images according to the position that viewers want to see and distance between viewer and MRA data. CONCLUSION: Proposed method overcome problems of conventional method that shows only specific projected image (z-axis projection) and give optimal depth information by converting mono MIP image to stereoscopic image considering viewers position. And can display any view of MRA data at spherical coordinates. If the optimization algorithm and parallel processing is applied, it may give useful medical information for diagnosis and treatment planning in real-time.
Angiography ; Arteries ; Brain ; Eye ; Head ; Linear Energy Transfer ; Magnetic Resonance Angiography ; Neck

The purpose of this study was to investigate the influence of hypothermia on the recovery time after either vecuronium or atracurium given by repeated bolus injection, and to determine the adequate time of administration of neuromuscular blockers during cardiopulmonary bypass. Two groups of 10 patients each were studied before(Tl), during(T2) and after(T3) hypothermia. Following an initial intravenous bolus dose of 2X ED95 of either vecuronium(Group I) or atracurium(Group II), repeated bolus dose of ED95 was injected whenever twitch tension had returned to 20% block of train-of-four response before bypass of control As a result, the action duration of vecuronium(from injection of loading dose to twitch tension=20%) was 29.5+/-5.5 mins, 103.1+/-12.0 mins and 70.8+/-9.9 mins before, during and after hypothermia, respectively. The eorresponding values for atracurium were 26.3+/-5.1 mins, 85.7+/-11.4 mins and 42.5+/-5.1 mins. We conclude that hypothermia increases significantly the duration of action of both muscle relaxants(P<0.001) and vecuronium is influenced by hypothermia more than atracurium. The rate of recovery of twitch height after hypothermia is more rapid in atracurium than vecuronium(P<0.001). Single bolus injection of ED95 of vecuronium administered just before cardiopulmonary bypass is suitable for maintaining the neuromuscular block throughout cardiopulmonary bypass.
Atracurium* ; Cardiopulmonary Bypass* ; Humans ; Hypothermia* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Thoracic Surgery* ; Vecuronium Bromide*