The diagnosis of retroorbital tumor is at times difficult and the decision as to the best surgical approach to orbital tumors is often difficult. The rapid development of diagnostic radiologic procedures has provided a means of more precisely defining the nature and extent of the lesion and with the advent of microsurgical techniques, they could allow safe access to the orbit transcranially. The advantage of the transcranial approach to orbital tumors is apparent for disease processes that arise in or extend to the intracranial cavity, and superior access to the apical portion of the optic nerve and to the medial and lateral superior quadrants of the orbit. Furthermore, good functional and cosmetic outcome is possible. The authors had experienced good results of transcranial approach in 15 cases of retroorbital tumors.
Diagnosis ; Optic Nerve ; Orbit

No abstract available.
Arteries* ; Heart Septal Defects, Ventricular*

No abstract available.
Heart* ; Hyperbilirubinemia* ; Thoracic Surgery*

Nine patients of clinically definite multiple sclerosis (MS) were examined by magnetic resonance imaging (MRI) at 1.0T. The MS plaques were seen in the brain and spinal cord in eight and three patients. respectively. The frequent sites of MS plaques were periventricular white matter, brain stem, and cervical cord. The shape of most brain MS plaques was round or finger-like configuration. The MS plaques showed high signal intensity on R2 weighted images and low or iso signal intensity on T1 weighted images in all nine cases. Contrast enhancement was seen in 4 cases. Mild brain atrophy was noted in 2 cases and mass effect in 1 case. The sites of cord MS plaques in three patients were C2-C4, C2-C5, and C4-C6 levels respectively. The cord MS plaques showed high signal intensity on T2 weighted image and contrast enhancement on Gd-DTPA enhanced T1 weighted images in all 3cases with mild cord expansion in 2 cases. In conclusion, MRI is a useful diagnostic tool in evaluationg the MS plaques involving central nervous system.
Atrophy ; Brain ; Brain Stem ; Central Nervous System ; Cervical Cord ; Gadolinium DTPA ; Humans ; Magnetic Resonance Imaging* ; Multiple Sclerosis* ; Spinal Cord ; White Matter

PURPOSE: This study was to determine the impacts of traumatic events and resilience on the professional quality of life (ProQoL) among clinical nurses. METHODS: In this cross-sectional correlational descriptive study, 325 nurses completed questionnaires of traumatic events, resilience, and ProQoL consisted of compassion satisfaction (CS) and compassion fatigue (CF). Data were analyzed by Spearman correlation analysis and hierarchical regression. RESULTS: Traumatic events positively correlated with CF. Resilience positively correlated with CS and negatively correlated with CF. In this study, multivariate analysis showed that traumatic events and resilience explained 24% of the variance in CS and 7% of the variance in CF. CONCLUSION: A nursing education to enhance resilience and recognition of CS and CF from stressful work-related traumatic events may benefit to improve the professional quality of life for clinical nurses.
Compassion Fatigue ; Education, Nursing ; Empathy ; Multivariate Analysis ; Quality of Life

BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae are main pathogens of bloodstream infection. We compared the epidemiology of ESBL-producing E. coli and K. pneumoniae. METHODS: From January 2003 through March 2007, we retrospectively investigated the clinical characteristics and comorbidities of patients with bloodstream infection by ESBL-producing E. coli and K. pneumoniae. RESULTS: During the study period, 79 patients (54 with E. coli and 25 with K. pneumoniae) with blood cultures positive for ESBL-producing E. coli or K. pneumoniae were studied. When comparing the source of bloodstream infections, urinary tract infections (UTIs) were more commonly caused by E. coli (24% vs. 0; P=0.007), and respiratory tract and soft tissue infection (36% vs. 15%; P=0.04, 12% vs. 0; P=0.03, respectively) were more commonly associated with K. pneumoniae. Among hospital-acquired bloodstream infection, third-generation cephalosporin was more commonly used in patients with E. coli than patients with K. pneumoniae (81% vs. 24%, P<0.001). Medical devices (central venous catheter and urinary catheter) were more commonly used in patients with K. pneumoniae. CONCLUSION: ESBL-producing E. coli bloodstream infection is more common in urinary tract infections. ESBL-producing K. pneumoniae is more common in respiratory tract infections and in skin and soft tissue infections. In hospital-acquired infections, ESBL-producing E. coli bloodstream infection is more common in biliary tract infection. ESBL-producing E. coli was more commonly associated with prior frequent antibiotics use and K. pneumoniae was more commonly associated with use of medical devices.
Anti-Bacterial Agents ; beta-Lactamases ; Biliary Tract ; Catheters ; Comorbidity ; Epidemiology* ; Escherichia coli* ; Humans ; Klebsiella pneumoniae* ; Pneumonia ; Respiratory System ; Respiratory Tract Infections ; Retrospective Studies ; Skin ; Soft Tissue Infections ; Urinary Tract Infections

From May, 1975 to August, 1986, we experienced 21 patients with ruptured aneurysm of the sinus of Valsalva. 1) Their ages ranged from 15 to 52 years with a mean age of 26.7 years, and 14 patients were male and 7 patients were female. Among 18 cases of which aneurysms occurred on the right sinus of Valsalva, 15 cases (83%) ruptured into the right ventricle, 1 case (6%) ruptured into the right atrium and 2 cases (11%) ruptured into the pulmonary artery. All 3 cases of which aneurysms occurred on the noncoronary sinus ruptured into the right atrium. 2) Clinical symptoms consisted of dyspnea (95%), palpitation (81%), chest pain (43%), orthopnea (33%), cough (14%), hemoptysis (5%), oliguria (5%), and fever (5%). In all patients continuous heart murmur was audible. Hepatomegaly (48%), pulmonary basal rale (14%), and pretibial pitting edema (19%) were also observed. 3) In all patients diagnosis was made with cardiac catheterization and angiography, and confirmed by operation excetpt one case. 4) Among 20 patients who had been performed corrective surgery, ventricular septal defect was observed in 16 patients (85%), aortic insufficiency in 5 patients (25%), pulmonary infundibular stenosis in 1 patient (5%), patent foramen ovale in 1 patient (5%), and tricuspid insufficiency in 1 patient (5%). Ventricular septal defect was observed in all 16 patients whose aneurysms of the right coronary sinus of Valsalva ruptured into the right ventricle and the pulmonary artery. 5) All patients survived operation, and no postoperative complication was found except 1 patient to whom reoperation was performed because of postoperative aortic insufficiency and detachment of the patch closure for ventricular septal defect. There was symptomatic improvement in all patients.
Aneurysm ; Aneurysm, Ruptured* ; Angiography ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Sinus ; Cough ; Diagnosis ; Dyspnea ; Edema ; Female ; Fever ; Foramen Ovale, Patent ; Heart Atria ; Heart Murmurs ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Hemoptysis ; Hepatomegaly ; Humans ; Male ; Oliguria ; Postoperative Complications ; Pulmonary Artery ; Pulmonary Subvalvular Stenosis ; Reoperation ; Respiratory Sounds ; Sinus of Valsalva*

Most congenital obstructions of right ventricular outflow occur at the infundibular, pulmonary valvular, or pulmonary arterial levels. Less frequently, stenosis is present in the sinus portion of the right ventricle and is caused by an obstructing aberrant muscle bundle or band crossing the chamber below the infundibulum. This abnormality has been called the double chambered right ventricle. We have reviewed our experience with 18 patients with a double chambered right ventricle who had been admitted to the SNUH. 1) Age distribution was from 2 to 36 years old with a mean age of 12.8 years. There were 13 female patients and 5 male patients with a 2.6:1 female to male ratio. 2) The chief complaints of the patients were dyspnea on exertion(50%), known congenital heart disease(27.8%), and cyanosis(16.7%), in that order. The physical findings were grade III-V/VI systolic murmurs and other findings of associated cardiac anomalies. 3) The electrocardiographic findings were as follow: left ventricular hypertrophy(33.3%), right ventricular hypertrophy(22.2%), and biventricular hypertrophy(22.2%), Pressure gradients within the right ventricle were noted in 13 cases(72.2%), and filling defects on right ventricular cineangiography were noted in 14 out of 15 cases(93.3%). The echocardiographic findings were not diagnostic, except for the associated cardiac anomalies. 4) 14 cases were operated with a result of aberrant muscle bundles in the right ventricular cavity. All were removed surgically. 1 case was confirmed by autopsy Other 3 cases(Who had pressure gradients within the right ventricular cavity and filling defects on the right ventricular cineangiogram) showed little symptoms, and there has been a continuous follow up on these patients. 5) The associated cardiac anomalies were as follows: 13 cases(72.2%) of ventricular septal defect, 1 case(5.6%) of bicuspid tricuspid valve, 1 case(5.6%) of persistent left sided superior vena cava, and 1 case(5.6%) of aortic regurgitation. There was 3 cases of isolated double chambered right ventricle(16.5%).
Adult ; Age Distribution ; Aortic Valve Insufficiency ; Autopsy ; Bicuspid ; Cineangiography ; Constriction, Pathologic ; Dyspnea ; Echocardiography ; Electrocardiography ; Female ; Follow-Up Studies ; Heart ; Heart Septal Defects, Ventricular ; Heart Ventricles* ; Humans ; Male ; Systolic Murmurs ; Tricuspid Valve ; Vena Cava, Superior

No abstract available.
Transposition of Great Vessels*

BACKGROUND: A ureteropelvic junction (UPJ) obstruction is a congenital anomaly commonly afflicting the pediatric population. However, it occurs more frequently in adults than is generally appreciated. To assess their characteristics, we have here compared and analyzed the clinical manifestations, causes, and outcomes of UPJ obstruction found in children and adults. MATERIALS AND METHODS: 102 patients (118 renal units) out of 182 patients (218 renal units), with diagnosed UPJ obstruction, were available for follow up. The follow-ups were retrospectively reviewed to determine the presenting symptoms, treatments, and clinical outcomes. Patients who were younger than 18 years of age were assigned to the pediatric group (44 patients), others the adult group (58 patents). RESULTS: The majority of the patients presented with flank pain (pediatric group: 68%, adult group: 76%). The majority of patients underwent a pyeloplasty (pediatric group: 50.9%, adult group: 62.3%). And the major cause of the UPJ obstruction was an intrinsic stenosis (pediatric group: 53%, adult group: 56%). CONCLUSION: The prevalence of bilateral UPJ obstruction in adults is evidently less prevalent than in pediatrics, and despite the late diagnosis, the surgical outcome is similar. A further investigation of UPJ obstruction will lead us to a more comprehensive understanding of the disease.
Adult* ; Child ; Constriction, Pathologic ; Delayed Diagnosis ; Flank Pain ; Follow-Up Studies ; Humans ; Pediatrics ; Prevalence ; Retrospective Studies