The purpose of this study is to identify the effects of the supportive nursing care for arthritis patients enrolled in a rheumatoid clinic. To achieve this purpose, this study adopted a quasi-experimental, pre- and post-test research design, categorized subjects into experimental and control groups. Outpatient clinic nurse alloted the subjects by experimental and control groups and nurse researcher meets the experimental subject with in-depth, direct personal interview and advices via telephone for 8 weeks. During this pre and after the treatment period, the level of pain, uncertainty, self-efficacy, family support, and perception for health were measured. Analyses for the measured results for pre- and post-test showed that the supportive program conducted during this study decreased the level of uncertainty and increased the perception of family support in experimental group. So, the supportive healing interpersonal communication service proved to be effective and this result justifies the argument that the role of the nursing professionals at out-patient clinic should be extended for the more qualified care for the patient.
Ambulatory Care Facilities ; Arthritis* ; Follow-Up Studies* ; Humans ; Nursing Care* ; Nursing* ; Outpatients ; Research Design ; Telephone ; Uncertainty

Central venous catheter (CVC) insertion is commonly used in the operating room and intensive care unit to monitor central venous pressure and secure an intravenous route to deliver medications and nutritional support that cannot be safely infused into peripheral veins. However, CVC insertion may be associated with serious complications such as arterial puncture, hematoma, pneumothorax, hemothorax, catheter infections, and thrombosis. Several methods have been recommended to prevent these complications. Here we report a case of massive hemothorax caused by attempts of CVC insertion into the internal jugular vein and subclavian vein in a patient with multiple trauma. CVC placement should be performed or supervised by an experienced physician to decrease the incidence of CVC-related complications. CVC insertion under ultrasound guidance is recommended.

PURPOSE: Estrogens control the development and cell proliferation of various tissues including the normal mammary epithelial cells, where they induce the expression of the immediate and delayed hormone-responsive genes. The proliferative effects of estrogen have been attributed to its ability to increase the expression of the key cell cycle regulatory genes responsible for cell cycle progression. However, the regulation of cell proliferation is only one aspect of estrogen function. It has also been well documented that estrogen plays a critical role in the etiology and progression of human breast and gynecological cancers. This tumorigenic effect of estrogen might be associated with its anti- apoptotic activities such as of Bcl-2 induction. The aim of this study was to clarify the role of E2IG5, which is an estrogen-induced downstream effector molecule, in breast cancer cell lines. RESULTS: This study shows that E2IG5 is a pro-apoptotic protein that is localized to the mitochondrial membrane via two distinct transmembrane domains. When over-expressed, it induces a mitochondrial permeability transition with the resultant of release cytochrome c and caspase activation. However, three out of four breast cancer cell lines lost their estrogen dependence of E2IG5 expression, which suggests the possible involvement of E2IG5 in the development of breast cancer. CONCLUSION: These results suggest that breast cancer cells may loose their pro-apoptotic signals and selectively use the proliferative mechanism of estrogen, which drives the normal mammary epithelial cells to transform into cancer cells. Further studies using breast cancer tissues will be needed.
Breast Neoplasms* ; Breast* ; Cell Cycle ; Cell Line* ; Cell Proliferation ; Cytochromes c ; Epithelial Cells ; Estradiol ; Estrogens ; Genes, Regulator ; Humans ; Mitochondrial Membranes ; Permeability

Endothelial progenitor cells (EPCs) have been reported to possess the capacity to colonize vascular grafts and hold promise for therapeutic neovascularization. However, limited quantities of EPCs have been the major factor impeding effective research on vasculoangiogenesis. In this study, cytokine and culture conditions necessary for the provision of large quantities of endothelial cells (ECs) were investigated. Cord blood was collected from 18 normal full-term deliveries and CD34+ cells were isolated by MACS system (Miltenyi Biotech, Bergish-Gladbach, Germany). To evaluate the effect of cytokines, CD34+ cells were cultured with various cytokine combinations, such as stem cell factor (SCF), flt3-ligand (FL), and thrombopoietin (TPO) with vascular endothelial growth factor (VEGF), interleukin-1beta, fibroblast growth factor-basic (FGF-b) as basic cytokines. The quantities of non-adherent and adherent cells were the greatest with SCF, FL and TPO. The addition of TPO to all other cytokines significantly increased the number of non-adherent and adherent cells (p< 0.05, Wilcoxon rank sum test). After four weeks of culture, adherent cells expressed endothelial specific markers such as KDR, CD31 and CD62E. Typical morphology of ECs was observed during culture, such as cord-like structure and cobblestone appearance, suggesting that the adherent cells were consistent with ECs. In this study, the experimental conditions that optimize the production of ECs for therapeutic neovascularization were described. And it was possibly suggested that TPO plays a major role in differentiation from EPCs to ECs.
Antigens, CD34/analysis ; Cell Differentiation/drug effects ; Cell Division/drug effects ; *Cell Separation ; Cells, Cultured ; Cytokines/pharmacology ; *Endothelial Cells/immunology ; Fetal Blood/*cytology ; Fetus ; Flow Cytometry ; Humans ; Research Support, Non-U.S. Gov't ; *Stem Cells/*immunology ; Thrombopoietin/pharmacology

BACKGROUND: Family physicians are interested in health promotion for maintaining one's sound health. But there is little information on what patients think about the practice of health promotion by family physicians. Therefore, we found out whether patients think that it is appropriate for family physicians to be concerned about problems relating to four health risk factors, and the patients' perception both of their own health problems and of the concern actually shown by their family physicians. METHODS: Patients who had visited our two family medicine offices from March to August 1998 was asked to complete a self administered questionnaire. Questions on attitudes to wards and perceptions of family physicians' interest in weight, smoking, drinking, and fitness problems were included. 586 questionnaires with adequate response were analyzed using chi square test and Mantel Haenszel's linear trend test. RESULTS: A total of 586 respondents consisted of 230 men and 356 women. Of the respondents, the proportion of people who thought that family physicians should be concerned about the health risk factors ranged from 83.6% in the case of smoking to 86.5% of fitness, but 76.6% thought their family physicians had in fact been interested in smoking and 72.2% thought so about fitness. There was a significant age group trend in the case of attitudes towards family physician concern for smoking with larger proportions of older patients (p<0.01). Significantly more women than men thought that their family physicians seemed interested in health risk factor with 62.2% to 70.0% in men and 78.6% to 80.9% in women (p<0.001). There were significant age group differences in proportions who thought that their family physicians seemed interested in weight (p<0.001), smoking (p<0.001), and drinking (p<0.05) problems except for fitness problem. 31.6% of the respondents thought that they had a weight problem, 20.5% smoking problem, 14.0% drinking problem, and 28.2% fitness problem. CONCLUSION: These results suggest that many patients thought that most of their family physicians seemed interested in health promotion, but felt the need that they should be come more interested.
Surveys and Questionnaires ; Drinking ; Female ; Health Promotion* ; Humans ; Male ; Physician's Role* ; Physicians, Family ; Risk Factors ; Smoke ; Smoking

OBJECTIVES: This study was performed to survey worker's demands for worksite medical care and agency's intention for offering worksite medical care in Group Health Service Agency. METHODS: One study subjects were employers, workers and office personnels in 167 factories. They were asked for medical care utilization behavior and worksite medical care demand. 121 employers(72.5%), 145 office personnels(86.8%) and 816 workers(60.5%) answered the questionnaire. The other subjects were doctors, nurses and administrators in 66 Group Health Service Agencies nationwide. They were asked for intention of offering worksite medical care in Group Health Service Agency through the mail survey. 31 doctors(47.0%), 38 nurses(57.6%) and 34 administrators answered the questionnaire. RESULTS: 87 percentage of doctors and 94 percentage of nurses had experiences of being requested to prescribe and laboratory examination. All nurses, 94 percentage of administrators and 76 percentage of doctors thought that it was necessary to give medical treatment at worksite. Also in worksite 85 percentage of employers, 86 percentage of office personnels and 81 percentage of workers answered that they accepted the worksite medical care when it would be given. CONCLUSIONS: Worksite medical care should be permitted because almost of all workers and employers requested worksite medical care, and doctors and nurses in Group Health Service Agency were willing to give worksite medical care and there was necessity to prevent occupational cerebrovascular disease.
Administrative Personnel ; Health Services* ; Humans ; Intention* ; Postal Service ; Questionnaires ; Workplace*

PURPOSE: The aim of this study was to evaluate the shear bond strength between Ni-Cr alloy and composite resin using universal adhesive systems coMPared to conventional method using metal primers. MATERIALS AND METHODS: For this study, a total of 120 cast commercial Ni-Cr alloy (Vera Bond 2V) disks were embedded in acrylic resin, and their surfaces were smoothed with silicon carbide papers and airborne-particle abrasion. Specimens of each metal were divided into 6 groups based on the combination of metal primers (Metal primer II, Alloy primer, Metal & Zirconia primer, MKZ primer) and universal adhesive systems (Single Bond Universal, All Bond Universal). All specimens were stored in distilled water at 37degrees C for 24 hours. Shear bond strength testing was performed with a universal testing machine at a cross head speed of 1 m/min. Data (MPa) were analyzed using one-way ANOVA and the post hoc Tukey's multiple comparison test (alpha=.05). RESULTS: There were significant differences between Single Bond Universal, All Bond Universal, Metal Primer II and Alloy Primer, MKZ Primer, Metal & Zirconia Primer (P<.001). CONCLUSION: Universal Adhesive system groups indicated high shear bond strength value bonded to Ni-Cr alloy than that of conventional system groups using primers except Metal Primer II. Within the limitations of this study, improvement of universal adhesive systems which can be applied to all types of restorations is recommended especially non-precious metal alloy. More research is needed to evaluate the effect of silane inclusion or exclusion in universal adhesive systems.
Adhesives ; Alloys* ; Head ; Water

PURPOSE: The laparoscopic adrenalectomy has become the golden standard procedure for adrenal tumors because of its many advantages. The purpose of our study was to compare the outcomes for patients who underwent a transperitoneal laparoscopic adrenalectomy with those of patients who had a conventional open adrenalectomy. Similar to the open adrenalectomy, the laparoscopic adrenalectomy was divided into anterior (LA: Laparoscopic anterior) and posterior (LP: Laparoscopic posterior) approaches. METHODS: Between January 1991 and September 1998, a retrospective review of consecutive ad renalectomies performed at Kyung Hee University Hospital was done. Outcome measurements of operative indications, tumor size, operation time, first oral intake, postoperative stay, and postoperative complications were reviewed. RESULTS: Eleven(11) laparoscopic adrenalectomies (4 LAs and 7 LPs) were performed in 11 patients and 47 open adrenalectomies [24 with an anterior, OA (Open anterior), approach and 23 with a posterior, OP (Open posterior), approach] in 43 patients. The LA approach showed a significantly shorter time to first oral intake (1.8 vs 3.4 days p=0.001) and postoperative hospital stay (5.5 vs 12.8 days p=0.001) compared to the OA approach. The LP approach also showed a significantly shorter time to first oral intake (0.9 vs 1.6 days p=0.046) and postoperative hospital stay (5.9 vs 9.9 days p=0.004) compared to the OP approach. There were no differences in tumor size, operation time, and postoperative complications between laparoscopic adrenalectomies and open adrenalectomies. CONCLUSION: The laparoscopic adrenalectomy is superior to the open adrenalectomy when performed by appropriately trained and skilled surgeons.
Adrenalectomy* ; Humans ; Length of Stay ; Postoperative Complications ; Retrospective Studies

BACKGROUND: An excessive accumulation of neutrophils in lung tissue has been known to play an important role in mediating the tissue injury among the adult respiratory distress syndrome, idiopathic pulmonary fibrosis and cystic fibrosis by releasing toxic oxygen radicals and proteolytic enzymes. Therefore, it is important to understand a possible mechanism of neutrophil accumulation in lung tissue. In many species, exposure to hyperoxic stimuli can cause changes of lung tissues very similar to human adult respiratory distress syndrome and neutrophils are also functioning as the main effector cells in hyperoxic lung injury. The purpose of the present study was to examine whether neutrophils function as a key effector cell and to study the nature of possible neutrophil chemotactic factors found in bronchoalveolar lavage fluid from the hyperoxia exposed rats. METHODS: We exposed the rats to the more than 95% oxygen for 24, 48, 60 and 72 hours and bronchoalveolar lavage(BAL) was performed. Neutrophil chemotactic activity was measured from the BAT fluid of each experimental groups. We also evaluated the molecular weight of neutrophil chemotactic factors using fast performance liquid chromatography and characterized the substances by dialyzer membrane and heat treatment. RESULTS: 1) The neutrophil proportions in bronchoalveolar lavage fluid began to rise from 48 hours after oxygen exposure, and continued to be significantly increased with exposure times. 2) Chemotactic index for neutrophils in lung lavages from rats exposed to hyperoxia was significantly higher in 48 hours group than in control group, and was significantly increased with exposure time. 3) No deaths occured until after 48 hours of exposure. However, mortality rates were increased to 33.3% in 60 hours group and 81.3% in 72 hours group. 4) Gel filtration using fast performance liquid chromatography disclosed two peaks of neutrophil chemotactic activity in molecular weight of 104,000 and 12,000 daltons. 5) Chemotactic indices of bronchoalveolar lavage fluid were significantly decreased when bronchoalveolar lavage fluid was treated with heat (56 degreesC for 30 min or 100 degreesC for 10 min) or dialyzed (dialyzer membrane molecular weight cut off: 12,000 daltons). CONCLUSION: These results suggested that the generation of neutrophil chemotactic factor and subsequent neutrophil influx into the lungs are playing an important roles in hyperoxia-induced acute lung injury. Neutrophil chemotactic factor in the lung lavage fluids consisted of several distinct components having different molecular weight and different physical characteristics.
Acute Lung Injury ; Animals ; Bronchoalveolar Lavage Fluid* ; Bronchoalveolar Lavage* ; Chromatography, Gel ; Chromatography, Liquid ; Cystic Fibrosis ; Hot Temperature ; Humans ; Hyperoxia* ; Idiopathic Pulmonary Fibrosis ; Interleukin-8 ; Lung ; Lung Injury ; Membranes ; Molecular Weight ; Mortality ; Negotiating ; Neutrophils* ; Oxygen ; Peptide Hydrolases ; Rats* ; Reactive Oxygen Species ; Respiratory Distress Syndrome, Adult

OBJECTIVES: This study sought to evaluate trabecular changes in the mandible using fractal analysis and to explain the transient osteopenia related to rapid orthodontic tooth movement after orthognathic surgery. MATERIALS AND METHODS: Panoramic radiographs were taken of 26 patients who underwent bilateral sagittal split ramus osteotomy. Radiographs taken before the surgery and 1 month after surgery were overlapped, and 40x40 pixel square regions of interest were selected near the mandibular canines and 1st molars. After the image processing procedure, the fractal dimension was calculated using the box-counting method. RESULTS: Fractal dimension after orthognathic surgery decreased in a statistically significant manner (P<0.05). The change in fractal dimension on the canine side had greater statistical significance as compared to that seen on the 1st molar side. CONCLUSION: This study found that bone density decreases after orthognathic surgery due to transient osteopenia related to the regional acceleratory phenomenon. This result can provide a guide to evaluating orthodontic tooth movement after orthognathic surgery.
Bone Density ; Bone Diseases, Metabolic ; Fractals ; Humans ; Mandible ; Molar ; Orthognathic Surgery ; Osteotomy, Sagittal Split Ramus ; Tooth Movement