PURPOSE: The purpose of this study was to develop a comprehensive self-management program promoting self efficacy for Type 2 diabetic patients. METHODS: The study was a methodological research design in which previous related research was reviewed to develop the comprehensive self-management program promoting self efficacy using self efficacy theory. RESULTS: Comprehensive self-management programs promoting self efficacy included the whole range of eight self-management domains: diet, exercise, medication, self-testing of blood glucose, complication or foot, stress, time, and general health, and consisted of four sources of self efficacy: enactive mastery experience, vicarious experience, verbal persuasion, and physiological and affective states, as strategies to promote self efficacy. Developmental methods included, in addition to large and small group education, individual education or counseling, and telephone counseling. CONCLUSION: Further studies are needed in community health centers or hospitals to establish the effects on self-management compliance and glycemic control of the comprehensive self-management program promoting self efficacy.
Blood Glucose ; Community Health Centers ; Compliance ; Counseling ; Diabetes Mellitus, Type 2 ; Diet ; Foot ; Humans ; Persuasive Communication ; Research Design ; Self Care ; Self Efficacy ; Telephone

BACKGROUND/AIMS: We compared the accuracy in the diagnosis of hepatic masses such as hepatocellular carcinoma (HCC), metastasis and hemangioma using enhancing pattern alone with using additional findings, and determined whether the additional findings could improve the diagnostic accuracy. METHODS/MATERIALS: Triphasic spiral CT images were retrospectively analyzed in 83 cases of hepatic lesions,' 40 HCC, 21 metastases, and 22 hemangiomas. Three observers made the diagnosis first by the enhancement pattern of the mass alone, and then, by the whole information. The diagnosis of a lesion was considered correct if the lesion was correctly categorized by at least two observers. Diagnostic accuracies of two sessions were compared with McNemar test. RESULTS: Using enhancing patterns alone, 31/40 HCC (78%), 8/21 metastases (38%), 21/22 hemangiomas (95%) were correctly diagnosed. The frequency of correct diagnosis was significantly improved when all images with additional findings were used: 36/40 (90%) HCC, 20/21 (95%) metastases, 22/22 (100%) hemangiomas (P=0.00006). Metastasis showed most prominent and statistically significant improvement in the diagnostic accuracy (P=0.0004). The number of correct diagnoses for HCC increased without statistical significance (P=0.17). However, the images with additional findings did not significantly contribute to the diagnosis of hemangiomas. The additional finidngs those led to correct diagnosis of metastases were multiple mass (7 cases), coexistence of primary malignancy (6 cases), and metastasis to other organ (1 case). The findings of liver cirrhosis were helpful to diagnose HCC correctly in 5 cases. CONCLUSION: The enhancing pattems of tumors were important in the diagnosis of hepatic masses in spiral CT. However, the additional finidngs were also helpful for the diagnosis of hepatic masses especially for the masses with atypical enhancement pattern. In metastases, the additional findings such as multiple masses or detection of primary malignant focus were useful to diagnose correctly.
Carcinoma, Hepatocellular ; Diagnosis ; Hemangioma ; Liver Cirrhosis ; Liver Neoplasms ; Neoplasm Metastasis ; Retrospective Studies ; Tomography, Spiral Computed*

PURPOSE: To evaluate the clinical course of visual acuity and foveal thickness in the idiopathic epiretinal membrane (ERM) after a vitrectomy with the use of triamcinolone. METHODS: We retrospectively reviewed the records of 30 patients (30 eyes) with ERM that were treated by vitrectomy from 2004 to 2008. Visual acuity and foveal thickness from optical coherence tomography imaging was obtained preoperatively and at every postoperative follow-up visit. RESULTS: Visual acuity improved by two or more lines of vision in 30%, 50%, 60%, and 70%, and stayed the same within +/-1 line in 47%, 50%, 40%, and 30% at one month, three months, five months, and seven months after surgery. Twenty-three percents of the subjects deteriorated by two or more lines of vision within one month after surgery. None of the subjects had reduced vision three months after surgery. Foveal thickness decreased significantly after surgery. The mean thickness was 409.7+/-107.9 microm before surgery and 288.6+/-66.1 microm seven months after surgery. Parameters which were significantly correlated with the final visual acuity included preoperative visual acuity (0.683), preoperative foveal thickness (0.544), and final foveal thickness (0.643) (p<0.005). CONCLUSIONS: Foveal thickness and visual acuity improved until seven months after the vitrectomy in patients with idiopathic ERM. Preoperative visual acuity, foveal thickness, and final foveal thickness had a significant correlation with the final visual acuity.
Aged ; Epiretinal Membrane/pathology/*surgery ; Female ; Follow-Up Studies ; Fovea Centralis/*pathology ; Humans ; Male ; Middle Aged ; Postoperative Period ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Visual Acuity ; Vitrectomy/*methods

Objectives: This study examined the level of depression and anxiety and the related factors, especially the knowledge and attitudes towards dementia, of people caring for a family member with dementia. Methods: Data on the demographics, care burdens, and clinical characteristics of dementia patients and their family caregivers were collected. The Center for Epidemiologic Studies Depression Scale (CES-D) and Korean Screening Tool for Anxiety disorders (K-ANX), Dementia Knowledge Scale (DKS), and Dementia Attitudes Scale (DAS) were performed. This study investigated whether depression and anxiety of caregivers differed according to the caregivers, patients, and the burden of caregivers. Multiple regression analysis was performed to investigate the potential factors that may influence the psychological symptoms in family caregivers. Results: There were 135 respondents. The scores of CES-D and K-ANX were 19.18±12.05 (probable depression) and 11.48±8.88 (mild anxiety), respectively. There was a significant difference in the degree of depression according to the level of education (F=4.14, p<0.05), the severity of dementia (F=3.63, p<0.05), and cohabitation with patients with dementia (t=2.07, p<0.05). On the other hand, the difference in the degree of anxiety was not significant depending on the stratified potential factors. The degree of depression in caregivers was positively associated with severe dementia (β=0.252, p<0.01) and negatively associated with the DAS score (β= -0.392, p<0.001). Anxiety was only inversely affected by the DAS score (β=-0.369, p<0.001). Conclusion This study shows that family caregivers of people with dementia experience high levels of depression and anxiety, which are influenced by the patient’s severity of dementia and the caregiver’s attitude toward dementia.

'Num-chin syndrome', isolated mental neuropathy, is a rare manifestaion of malignant hernatologic diseases, but important sign for early diagnosis and prediction of clinical course and prognosis. Here we report 7 cases of numb-chin syndrome; one in leukemic transformation of malignant lymphoma, one in blastic crisis of chronic myelogenous leukemia and 5 in acute leukemia Two cases of acute leukemia revealed the 'numb-chin sign' in early course of disease before the diagnosis of leukemia and other three in aggravating state of acute leukemia. The therapeutic response and prognosis was poor and 5 cases expired in a few months.
Diagnosis ; Early Diagnosis ; Hematologic Diseases* ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Lymphoma ; Prognosis

The effects of deliberate hypotension by sodium nitroprusside (SNP) on the cardiovascular system and dosage of SNP were studied in 10 patients undergone Cotrel-Dubousset instrumentation for the operative treatment of scoliosis, spinal stenosis or herniated intervertebral disc. Mean arterial pressure decreased significantly (p<0.05), but cardiac output, central venous pressure and sytemic vascular resistance showed no significant change, The correlations between average dose of SNP and age, body weight, and age to weight ratio were r= -0.4 (p>0.05), r= -0.2 (p>0.05), and r= - 0.25 (p>0.05) respectively. The amount of whole blood transfused during the operation was 5. 3+/-1 .7 units. Hemoglobin and hematocrit decreased significantly (p<0.05) from 11.3+/-1.3g/dl and 33.7+/-4.1% to 10.1+/-1.5g/dl and 30+/-4.1% during operation.
Anesthesia* ; Arterial Pressure ; Body Weight ; Cardiac Output ; Cardiovascular System* ; Central Venous Pressure ; Halothane* ; Hematocrit ; Humans ; Hypotension* ; Intervertebral Disc ; Nitroprusside* ; Scoliosis ; Sodium* ; Spinal Stenosis ; Vascular Resistance

PURPOSE: Small-for-size syndrome (SFSS) is a major problem in liver surgery, and splenectomy has been used to prevent SFSS. However, it is unknown whether splenectomy has the same effect on liver regeneration in both standard and marginal hepatectomy. The aim of this study is to see a difference in effect of splenectomy on liver regeneration according to the amount of liver resection. METHODS: Thirty male Sprague-Dawley rats (220 to 260 g) were divided into the following five groups: control (n = 6), 70% hepatectomy (n = 6), 70% hepatectomy with splenectomy (n = 6), 90% hepatectomy (n = 6), and 90% hepatectomy with splenectomy (n = 6). The animals were euthanized 24 hours after surgery and liver specimens were obtained. To assess liver regeneration, we performed immunohistochemistry of liver tissue using 5-bromo-2-deoxyuridine (BrdU) labeling and Western blot analysis of hepatic growth factor (HGF) and transforming growth factor-beta (TGF-beta) in the liver tissue. RESULTS: The splenectomized subgroup had a higher BrdU-positive cell count in the 90% hepatectomy group, but not in the 70% hepatectomy group (P < 0.001). Splenectomy significantly decreased TGF-beta expression (P = 0.005) and increased the HGF to TGF-beta ratio (P = 0.002) in the 90% hepatectomy group, but not in the 70% hepatectomy group. CONCLUSION: The positive effect of splenectomy on liver regeneration was greater in the group with the larger liver resection. This phenomenon may be related to the relative balance between HGF and TGF-beta in the liver.
Animals ; Blotting, Western ; Cell Count ; Hepatectomy ; Humans ; Immunohistochemistry ; Liver ; Liver Regeneration ; Male ; Rats ; Rats, Sprague-Dawley ; Splenectomy ; Transforming Growth Factor beta

The surgical methods of injured peripheral nerve were limited to end-to-end neurorrhaphy, nerve graft, neurotization, etc. Recently, Several studies were executed about end-to-side neurorrhaphy in peripheral nerve injury. The purpose of this study is to investigate the axonal regeneration of end-to-side neurorrhaphy in rats, as alternative surgical method for peripheral nerve injury comparing with the state of normal, denervated, and end-to-end neurorrhaphy. Sixty female Sprague-Dawley rats were divided into four groups; group I as normal control group, group II as denervated control group, group III as end-to-end neurorrhaphy group, group IV as end-to-side neurorrhaphy group. At postoperative 4, 8, 12, 16, 20 and 24 week, nerve regeneration was assessed through electrophysiologic and histological studies. The results obtained were as follows: 1. In electrophysiologic test, the mean amplitude was higher in normal control group(group I) than either in end-to-end neurorrhaphy group(group III) or in end- to- side neurorrhaphy group(group IV)(p < 0.05). But there is no significant difference between group III and group IV. 2. The mean number of regenerating myelinated nerve fibers was higher in group I than either in group III or in group IV(p < 0.05). But there is no significant difference between group III and group IV, except at postoperative 16 week. 3. The mean number of motor end-plates at postoperative 24 week was 20.5 in group III and 18.2 in group IV, but there is no significant difference between group III and group IV. In conclusion, end-to-side neurorrhaphy through an epineural window could induce distal nerve regeneration by collateral sprouting of main peripheral nerve and positively reflected in functional improvement of the target muscle.
Animals ; Axons ; Female ; Humans ; Motor Endplate ; Nerve Fibers, Myelinated ; Nerve Regeneration* ; Nerve Transfer ; Peripheral Nerve Injuries ; Peripheral Nerves ; Rats* ; Rats, Sprague-Dawley ; Regeneration ; Transplants

PURPOSE: We retrospectively reveiwed the pathologic changes and Hounsfield unit of the low density lesion in solid mass on CT. MATERIALS AND METHODS: Pathologically proved solid mass was evalualed in regard to the shape and margin of the low density in the mass on the CT scans of 23 patient. The CT number of the low density lesion was correlated with the pathologic changes. RESULTS: Pathologic changes of the low density lesions were ;necrosis (n=17), hemorrahage (n=13), cyst (n=4), myxoid degeneration (n=2), hyaline degeneration (n=l), fibrosis (n=l), and mixed cellularity (n=l). In 14 cases, more than 2 pathologic changes were seen. In 11 cases, necrosis was associated with hemorrhage. The CT number ranged from 11.5 to 44.9 Hounsfield units(HU) (mean, 25.2HU). The average CT number was 26.9HU in hemorrhage and necrosis, 17.2HU in cystic change, 20.9HU in myxoid degeneration, 35.7HU in hyaline degeneration, 22.3HU in fibrosis, and 21.4HU in mixed cellularity. The hemorrhage and necrosis in 17 cases showed irregular margin, amorphous shape, and showed centrifugal distribution. The cystic change in 4 cases showed well defined margin, round shape, and peripheral location in solid mass. CONCLUSION: The low density lesions in solid mass on CT represented variable pathologic changes; necrosis, hemorrhage, cyst, myxoid degeneration, hyaline degeneration, fibrosis, and mixed cellularity. Pathologic changes would not be differentiated on the basis of CT number.
Fibrosis ; Ganglion Cysts ; Hemorrhage ; Humans ; Hyalin ; Necrosis ; Retrospective Studies ; Tomography, X-Ray Computed

Concha bullosa is a common anatomic variation of the middle turbinate; however, sinusitis secondary to the concha bullosa is rare. A 52-yr-old woman presented with nasal obstruction and posterior nasal drip. Computed tomography and examination of the nasal cavity revealed septal deviation on the left side, and a massive concha bullosa and maxillary sinusitis on the right side. The lateral lamella of the affected turbinate was removed and the inspissated material was drained. Histopathologic examination of the excised lesion in the concha bullosa revealed bacterial colonies in the mucus plug. We report here on a massive concha bullosa with secondary maxillary sinusitis.
Anatomic Variation ; Female ; Humans ; Maxillary Sinus ; Maxillary Sinusitis ; Mucus ; Nasal Cavity ; Nasal Obstruction ; Sinusitis ; Turbinates