Peterson's hernia is an internal hernia that can occur after Roux-en-Y anastomosis. It often accompanies small bowel volvulus and is prone to strangulation. Reconstruction of intestinal continuity after massive small bowel resection in a patient who undergoes near total gastrectomy and Roux-en-Y anastomosis can be difficult. A 74-year-old man who had undergone a near total gastrectomy and Roux-en-Y gastrojejunostomy for stomach cancer presented with abdominal pain. The preoperative computed tomography showed strangulated small bowel volvulus. During the emergent laparotomy, we found a strangulated Peterson's hernia with small bowel volvulus. After resection of the necrotized intestine, we made a new Roux-en-Y anastomosis connecting the remnant stomach and the jejunum with a transverse colon segment. We were safely able to connect the remnant stomach and the jejunum by making a new Roux-en-Y anastomosis utilizing a transverse colon segment as a new Roux-limb by two stage operation.
Abdominal Pain ; Aged ; Anastomosis, Roux-en-Y ; Colon, Transverse* ; Extremities* ; Gastrectomy ; Gastric Bypass ; Gastric Stump ; Hernia* ; Humans ; Intestinal Volvulus* ; Intestines ; Jejunum ; Laparotomy ; Stomach Neoplasms

BACKGROUND: The more vital organ blood flow during cardiopulmonary resuscitation (CPR), the more successful outcome. The worldwide CPR drug of choice, epinephrine also has some limitations and is often challenged by another catecholamine drug. This study was designed to compare the effects of epinephrine with those of vasopressin and epinephrine mixture on cerebral no-reflow during closed-chest CPR in a rabbit model of ventricular fibrillation. DESIGN: Prospective, randomized, experimental study. SETTING: University research laboratory. SUBJECTS: Domestic rabbits,3 to 6 months of age InteNentions : Four rabbits were randomly allocated to receive only 0.020 mg/kg of epinephrine(group 1) and another four rabbits were received both 0.020 mg/kg of epinephrine and 0.8 U/kg of vasopressin after 5 mins of cardiac arrest(group 2). MEASUREMENTS AND MAIN RESULTS: Carotid arterial blood flow and arterial gas analysis were showed no statistical difference between two groups but in the points of cerebral no reflow area and fluorescence exposure time, there were significant differences(group 1,5.15+/-.45%, group 2, 6.38+/-.54%, p=.029/ group 1; 29.65+/- 17.09 seconds, group 2;17.98+/- 18.75 seconds, p=.014). CONCLUSIONS: In cardiac arrest there is some synergistic effect with epinephrine and vasopressin mixture on cerebral no-reflow phenomenon.
Cardiopulmonary Resuscitation* ; Epinephrine* ; Fluorescence ; Heart Arrest ; No-Reflow Phenomenon ; Prospective Studies ; Rabbits ; Vasopressins* ; Ventricular Fibrillation

In order to measure the MPD with 8-methoxypsoralen, we selected 49 Korean healthy male vlunteers without phototoxic or photosensitive dermatoses. They were divided to 3 groups (Immediate; group 1, 1 hour; group 2, 2 hours', group 3) according to the waiting time, intervals of application of photosensitizer a,nd UVA:irradiation. The reaults were summarized as follows: 1. MPDs of group 1 had no clinical significance. 2, MPDs of group 2 were more than those of group '3 independently of application methods of photosensitizer. 3. In the cases of topical application of 8-MOP, MPDs of group 3 according to reading interval (24 hours, 48 hours and 72 hours after UVA irradiation) were 3.4+/-2.9 J/cm2, 1.9+/-l.5 J/cm' and l. 7+1, 2/cm, respectively. 4 In the cases of oral administration of 8-MOP, MPDs of group 3 according to reading; interval as topical application of 8-MOP were 7.1+/-2.3 J/cm, 4.4+/-1.1 J/ cm2 and 4.2+/-l.2 J/cm2, respectively. 5 MPL)s accarding to the skin types as follows; (waiting time; 2 hours, read- ing interval; 48 hours) a. In the case of topical application of 8-MOP, MPDs of the skin type ]II, 1V and V were 0.9+/-0.5 J/cm2, 1.8+/-1.1 J/cm2 and 3.0+/-l.3 J/cm2 respectively. b. In the case of oral administration of 8-MOP, MPDs of skin type g, W and were 3.5+/-1.1 J/cm2, 4.7+/-1.3 J/cm2 and 6.9+/-l.8 J/cm2, respectively.
Administration, Oral ; Humans ; Male ; Methoxsalen ; Skin ; Skin Diseases

No abstract available.
Bronchiolitis ; Epidemiology ; Pneumonia ; Respiratory Syncytial Viruses

In order to assess the epidermal glycogen in the epidermal hyperplastic disease, PAS(Periodic Acid Schiff) stain with or without diastase is used. Epidermal PAS positive reaction is significantly increased in psoriasis (90. 0%), verruca vulgaris (100%) and lichen simplex chronicus (100%) than control group (12, 5%) Epidermal PAS positive reaction is relatively increased in prurigo nodularis(66. 7 %) and chronic contact dermatitis (75%) Strong PAS positive reaction is noticed in 3 of 5 cases (60%) with verruca vulgaris, but none of 22 cases with psoriasis. It is suggested that epidermal glycogen epidermal hyperplasia and that the more glycogen accumulated. than control group (12. 5%) in 3 of 5 cases (60%) with verruca vulaccumulation is accompanied with the hyperplastic the epidermis is, the more glycogen accumulated.
Amylases ; Dermatitis, Contact ; Epidermis ; Glycogen* ; Hyperplasia* ; Neurodermatitis ; Prurigo ; Psoriasis ; Warts

PURPOSE: The purpose of this study was to identify clusters of nursing competency, and investigate the influence of reflective thinking, team learning climate, and learning organization building according to nursing competency clusters. METHODS: Participants were 244 clinical nurses who worked in 4 general hospitals in Gwangju Metropolitan City. Data were collected by self-report questionnaires during June and July, 2011. Nursing competency, levels of reflection hierarchy, team learning climate, and learning organization building were measured. Data were analyzed using frequencies, means, t-test, one-way ANOVA, Pearson correlation coefficients, and K-means cluster analysis with SPSS/WIN 20.0 version. RESULTS: Nursing competency correlated positively with intensive reflection, reflection, team learning climate, and learning organization building (p<.001). There were three clusters of nursing competency in a clinical ladder, which were derived from cluster analysis, grouped as high, middle, and low competency. Intensive reflection, reflection, team learning climate, and learning organization building showed significant differences according to grouping of nursing competency. CONCLUSION: The results indicate that developing intensive reflection, reflection, team learning climate, and learning organization building would be useful strategies for enhancement of nursing competency.
Career Mobility ; Climate ; Hospitals, General ; Learning ; Professional Competence ; Surveys and Questionnaires ; Thinking

A lg year-old female patient with pityriasis lichenoides et varioliforrnis acuta (PLEVA) was been treated with PUVA, At first, she was treated with tetracycline for 8 weeks with improvement somewhat. But 2 months later, her skin lesions aggravated slowly. So, we tried to treated her with PUVA and then she was cleared completely. The initial dose of UVA was 5 J/cm The UVA dosage increased by 10g of the previous exposure and increased to the maximum dose, 15 J/cm The patient exposed to UVA R times per week. 12 times after the PUVA therapy, the skin lesions begin to improve and completely improved at 21 times of Pl.JVA therapy. She was followed up every week and there was no side effect except hyperpigrnentation till 24 months. The total dose during treatment is 210 J/cm.
Female ; Humans ; Photochemotherapy* ; Pityriasis Lichenoides* ; Pityriasis* ; PUVA Therapy ; Skin ; Tetracycline

PURPOSE: Diabetic nephropathy is the most common cause of end stage renal disease and the incidence is progressively increasing. The aim of this study was to investigate the differences of 99mTc-DMSA renal uptake among diabetic patients with normoalbuminuria, microalbuminuria and overt proteinuria, and then to determine the clinical usefulness of 99mTc-DMSA in predicting early diabetic nephropathy. MATERIALS AND METHODS: 99mTc-DMSA scan was performed and a total renal uptake of 99mTc-DMSA was measured in 145 diabetic patients. Patients were divided into 3 groups according to the amount of 24 hour urinary albumin excretion as Group I (normoalbuminuria, 74 cases), Group II (microalbuminuria, 39 cases), and Group III (overt proteinuria, 32 cases). The differences of 99mTc-DMSA renal uptake among the 3 groups and the correlation between the renal uptake of 99mTc-DMSA and other clinical parameters were analyzed. RESULTS: The total renal uptake of 99mTc-DMSA of Group II (40.8+/-11.0%) was significantly lower than that of Group I (54.4+/-6.3%, p<0.001). The uptake of Group III (27.7+/-12.0%) was significantly lower than those of both GroupI and Group II (p<0.001). 99mTc-DMSA total renal uptakes correlated negatively with serum creatinine level (r=-0.629, p<0.001) and positively correlated with creatinine clearance rate (r=0.702, p<0.001). CONCLUSION: 99mTc-DMSA total renal uptake of diabetic patients with microalbuminuria was significantly decreased compared with that of patients of normoalbuminuria. Therefore, 99mTc-DMSA scan can be used as a diagnostic study for early detection of the diabetic nephropathy.
Creatinine ; Diabetic Nephropathies ; Humans ; Incidence ; Kidney Failure, Chronic ; Proteinuria ; Technetium Tc 99m Dimercaptosuccinic Acid*

This treatise summarizes the medical facts about the persistent vegetative state(PVS) and the associated issues. In August 1998, the opinions of the 380 neurologists and the 1007 neurosurgeons are inquired about the diagnostic criteria of PVS, the degree and the withdrawal of treatment on PVS patients. The response rate is 18.8%. The diagnostic criteria of PVS is determined by the items approved above 5007o of responses. (1) no evidence of cerebral function and an inability to interact with visual, auditory stimuli and follow commands. (2) maintaining the respiratory function with spontaneous respiration and normal respiratory pattern. (3) spontaneous eye opening and eye ball movements without sustained tracking. (4) variably preserved brain stem reflexes. (5) presence of sleep-wake cycles. (6) (1)-(5) symptoms should be persist for 6 months after the development of vegetative state. (7) the diagnostic criteria of PVS should be applied more than 3 times during the minimum observation period. (8) this diagnostic criteria of PVS could be applied to adults over 7 ages. As to the degree of treatment, nasogastric tube feeding and air-way keeping through the tracheostomy are approved over 9007b. Also antibiotics can be used in infection. As to the withdrawal of treatment, do not resuscitate order of patient s family is accepted by 46.1% in an emergency condition like cardiac arrest. But discharge against medical advice by the patient s family is accepted by 73.107o in non-emergency condition. In the case of neonates, parents decision is more determinative than any other thing.
Adult ; Anti-Bacterial Agents ; Brain Stem ; Emergencies ; Enteral Nutrition ; Heart Arrest ; Humans ; Infant, Newborn ; Korea* ; Parents ; Persistent Vegetative State* ; Reflex ; Respiration ; Tracheostomy

PURPOSE: This study was a methodological research conducted to develop a clinical ladder system for operating nurses. METHODS: Participants were 20 OR nurses, working in C Hospital, who had a mean tenure of 6 years and 10 months. Data collection consisted of 4 focus group interviews during May and June 2009. The content analysis method of Kim and Lee (1986) was used to analyze the data. Two clinical expert groups consisting of 16 nurses verified the content validity of the preliminary system from September 16 to 26, 2009 using Kim's tool (1999). RESULTS: The final clinical ladder system consisted of goals, core values, and 4 domains of practice related to core values, which were defined as professional value, perioperative nursing practice, education/research, and collaboration/leadership. Eleven nursing competencies and 44 behavior indicators were included in accordance with the 4-step ladder. The 4 operation systems for the clinical ladder system were the promotion system, continuous learning system, reward system, and support system. CONCLUSION: The results indicate that nursing managers need to pay more attention to developing a clinical ladder system for nurses.
Career Mobility ; Data Collection ; Focus Groups ; Learning ; Operating Rooms ; Perioperative Nursing ; Reward