Myometrial pregnancy developing in an previous cesarean section scar is the rarest of all ectopic pregnancy and provavly one of the most dangerous because of the risk of rupture and hemorrhage. For a young patient wanting to maintain her fertility, an earlier diagnosis and more conservative treatment are highly desirable. We present a case of an ectopic pregnancy embedded in the myometrium of a previous cesarean section scar in which the patient preserved her fertility through more noninvasive method, transvaginal ultrasound-guided Methotrexate injection.
Animals ; Cesarean Section* ; Cicatrix* ; Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Methotrexate* ; Mice ; Myometrium* ; Pregnancy ; Pregnancy, Ectopic* ; Rupture

This study was performed for the comparison of the therapeutic efficiency between 6-month (2tHER/4HER) and 9-month (9HER) short-course chemotherapy under the programe conditions for pulmonary tuberculosis in terms of sputum AFB negative conversion rate, remedial interruption rate and cost effectiveness analysis. Two hundreds and ninty three patients treated with 9HER and 641 treated with 2HERZ/4HER had been discharged from 22 health centers in Seoul from May 1, 1993 to April 30, 1994. Seven hundreds and seventeen was subsequently analysed excluding 217 patients due to remedial interruption. The results: 1. Bacteriological negative conversion rate in 9HER regimen and 2HERZ/4HER regimen was 97.8% and 96.4% respectively (p>0.05). But the early treatment period, negative conversion rate in 2HERZ/4HER regimen was very higher than in 9HER regimen(p<0.01). 2. Remedial interruption rate for 9HER regimen and 2HERZ/4HER regimen was 34.1% and 13.6% respectively. The primary reason for the interruption was transfering to other clinics and this interruption was high within 3months. 3. Cost effectiveness for 2HERZ/4HER regimen was higher than 9HER regimen. The difference cost effectiveness ratio was 2.33 at the first sputum test and 1.69 at the last sputum test.
Cost-Benefit Analysis ; Drug Therapy* ; Humans ; Seoul* ; Sputum ; Tuberculosis, Pulmonary*

It is widely recognized that manipulation of body position takes advantage of the influences of gravity for improving oxygenation. The study aims to determine the effects of positioning(supine, prone, right lateral decubitus and left lateral decubitus positions) applied to the mechanically ventilatory acute respiratory failure patients on arterial oxygen partial pressure(PaO2), alveolar arterial oxygen tension difference(AaDO2), mean aterial pressure, peak inspiratory pressure and plateau pressure. Thirty two acute respiratory failure patients admitted to the medical intensive care unit at Kangnam St. Mary's Hospital, The Catholic University of Korea from March 1997 to January 1998, were divided into three groups by radiographic evidence of unilateral or bilateral lung disease. In group 1 with dominant right lung disease were twelve subjects, group 2 with dominant left lung disease had eight subjects and group 3 had twelve subjects with bilateral lung disease. The variables were measured in 30 minutes after each position of supine, prone, good lung down lateral decubitus and sick lung down lateral decubitus position. The position order was done at random by Latin squre design. The results are as follows; 1) With group 1 patients, the PaO2 in the left lateral decubitus and prone position were 126.8+/-30.8 mmHg and 106.7+/-36.8 mmHg, respectively(p=0.0001). 2) With group 2 patients, the PaO2 in the prone and the right lateral decubitus position were 121.7+/-44.7 mmHg and 118.5+/-31.7 mmHg, respectively (p=0.0018). 3) With group 3 patients, the PaO2 was 143.6+/-36.6 mmHg in the prone position (p=0.0001). 4) With group 1 patients, the AaDO2 in the left lateral decubitus and the right lateral decubitus position were 178.1+/-29.7 mmHg and 233.1+/-24.4 mmHg, respectively(p=0.0001). 5) With group 2 patients, the AaDO2 in the prone and the left lateral decubitus postion were 184.0+/-39.5 mmHg and 231.0+/-23.9 mmHg, respectively(p=0.0019). 6) With group 3 patients, the AaDO2 in the prone and the supine postion were 377.1+/-35.6 mmHg and 435.7+/-13.1 mmHg, respectively (p=0.0001). 7) There were no differences among the mean arterial pressure, peak inspiratory pressure and plateau pressure for each of the supine, prone, left lateral decubitus and right lateral decubitus position. The results suggest that oxygenation may improve in mechanically ventilatory patients with unilateral lung disease when the position is good lung dependent and prone, and patients with bilateral lung disease when the position is prone without any effects on the mean arterial pressure and airway pressure. It is suggested that body positions improve ventilation/perfusion matching and oxygenation need to be specified in patient care plans.
Arterial Pressure ; Gravitation ; Humans ; Intensive Care Units ; Korea ; Lung ; Lung Diseases ; Oxygen* ; Partial Pressure* ; Patient Care ; Prone Position ; Respiratory Insufficiency

PURPOSE: This study was conducted to examine the effects of a delirium management program on nursing practice and nurses' stress in comprehensive nursing care service units. METHODS: A non-equivalent control group pretest-posttest design was used. The participants were 70 nurses in comprehensive nursing care service units. The nurses were assigned to either a experimental group (n=35) or a control group (n=35). The experimental group received a delirium management program. Data were analyzed using χ² test, Fisher's exact test, independent t-test and ANCOVA. RESULTS: The experimental group showed higher nursing practice than the control group (F=7.86, p=.007). The experimental group showed lower nurses' stress than the control group (F=10.73 p=.002). CONCLUSION The findings indicated that a delirium management program was an effective intervention to improve nursing practice and reduce nurses' stress in comprehensive nursing care service units.

Neural tube defects are reported one of the important congenital malformation in the world, with an incidence of 1.4 to 2 per 1000 pregnancies. Maternal serum AFP at the second trimester is used as screening test. But this is associated with numerous causes, including twins, fetal death, misdated pregnancies, cystic hygromas, teratomas, renal abnormalities, esophageal atresia and aberrations in the placenta. If the AFP level was elevated, targeted ultrasonography should be evaluated for confirming the gestational age and fetal viability, fetal number. Then if the ultrasonographic examination is nondiagnostic, or if an NTD is suspected, amniotic fluid AFP should be measured with acetylcholinesterase. But the false positive rate of the AF-AFP is high, and there is 0.3% of the false positive rate in amniotic acetylcholinesterase. This time the women with normal ultrasonographic examination continue the pregnancy after counseling of family history, past history with follow up of ultrasonography. We report a case with elevated second trimester MS-AFP, AF-AFP and positive amniotic acetylcholinesterase, but in which repeated sonographic findings were normal and result in delivery of a healthy baby without anomalies.
Acetylcholinesterase* ; Amniotic Fluid ; Counseling ; Esophageal Atresia ; Female ; Fetal Death ; Fetal Viability ; Follow-Up Studies ; Gestational Age ; Humans ; Incidence ; Lymphangioma, Cystic ; Mass Screening ; Neural Tube Defects ; Placenta ; Pregnancy Trimester, Second ; Pregnancy* ; Teratoma ; Ultrasonography

Isolated torsion of the fallopian tube in postmenopausal women is rare. In this case report, we detail the case of a 53-year-old patient who presented with adenomyosis and a left hydrosalpinx with high levels of CA 125 and CA 19-9. The isolated torsion of the left hydrosalpinx was observed during the operation. The serum levels of CA 125 and CA 19-9 were reduced from 129.62 and 348 to 58.2 and 12.41 U/mL, respectively, after total laparoscopic hysterectomy with salpingectomy. On radiologic evaluation, there were no other factors that may have influenced the increase in serum levels of CA 125 and CA 19-9 in this patient, which were reduced after operation. To the best of our knowledge, this is the first case of association between perioperative changes in CA 19-9 levels and isolated torsion of the fallopian tube.
Adenomyosis ; CA-125 Antigen ; CA-19-9 Antigen ; Fallopian Tubes ; Female ; Humans ; Hysterectomy ; Middle Aged ; Salpingectomy

Obstructive sleep apnea (OSA) is characterized by a disorder of breathing with prolonged partial and/or complete airway obstruction which causes frequent arousal during sleep. The prevalence of OSAS is approximately 2%–3.5% in children. It is mainly caused by enlarged tonsils and adenoids. Obesity, craniofacial abnormality, and neuromuscular disease are also relevant predisposing factors. Snoring is the most common presenting complaint in children with OSA, but the clinical presentation varies according to age. The pathogenesis of OSA is complex and involved in multifactorial, relative roles of anatomic and neurohumoral factors. The role of the nose is considered a component of the pathophysiology of OSA. It is unlikely that the first manifestation of OSA is intermittent snoring with nasal obstruction, often considered a coincidental finding. Childhood OSA should be diagnosed and treated, if clinically suspected, because various symptoms, signs, and consequences can be improved with proper management. Adenotonsillectomy is the first-line treatment modality in pediatric OSA with adenotonsillar hypertrophy. In addition, treatment of allergic rhinitis, nonallergic rhinitis, and other structural problems of the nasal cavity, if it is needed, may be included in the treatment of OSA.
Adenoids ; Airway Obstruction ; Arousal ; Causality ; Child* ; Craniofacial Abnormalities ; Humans ; Hypertrophy ; Nasal Cavity ; Nasal Obstruction ; Neuromuscular Diseases ; Nose ; Obesity ; Palatine Tonsil ; Prevalence ; Respiration ; Rhinitis ; Rhinitis, Allergic ; Sleep Apnea, Obstructive* ; Snoring