Epstein's syndrome is a rare disease whish is characterized by the association of thrombocytopenia, macrothrombocytopathia, nephritis and deafness. We experienced a case of Epstein's syndrome in a 12 years old male patient who was presented with a life long history of bleeding, usually as epistaxis, bilateral sensorineural deafness and hematuria with proteinuria starting in late childhood. Hematologic studies showed thrombocytopenia with giant platelets and anemia. A bone marrow aspirate revealed the megakaryocytes to be adequate in number and many giant size platelets. Platelet do not respond to addition of A and epinephrine; collagen and ristocetin induced agglutination response is decreased. It is difficult to be certain the association of thrombocytopenia with giant platelets, nephritis and deafness constitutes a new hereditary disease with a distinct pathogenesis or if it is an expansion of the well recognized Alport's syndrome of hereditary nephritis deafness. We report a case of Epstein's syndrome syndrome with brief review of related literatures.
Agglutination ; Anemia ; Blood Platelets ; Bone Marrow ; Child ; Collagen ; Deafness ; Epinephrine ; Epistaxis ; Genetic Diseases, Inborn ; Hematuria ; Hemorrhage ; Humans ; Male ; Megakaryocytes ; Nephritis ; Nephritis, Hereditary ; Proteinuria ; Rare Diseases ; Ristocetin ; Thrombocytopenia

PURPOSE: This study was conducted to examine the degrees of depression and activities of daily living (ADLs), and to identify factors that predict depression in elderly patients. METHODS: The sample was149 patients (80% female; mean age 79.1) from three geriatric hospitals located in small cities and who agreed to participate in the study. Data were collected by staff nurses involved in direct patient care from October to September 2009. The level of depression was measured on a daily basis for seven days using a 13-item scale. Patients' ADLs was measured using a modified 10-item Bathel ADLs scale. Data were analyzed using SPSS/WIN 17.0. RESULTS: Mean depression score was 10.05+/-4.77 out of 26 points and about 27% was assessed as depressed with more than 13 points. Multiple regression analysis showed that low educational level, absence of spouse and fewer family visits predict depression. In addition, low ADLs and sleep disturbance predict depression. CONCLUSION: Nursing care providers need to be concerned about ADLs of older patients and should develop nursing activity programs to increase their in-hospital physical activities. It is also important care for older patients' sleep and encourages family visits to decrease their depression.
Activities of Daily Living ; Aged ; Depression ; Humans ; Motor Activity ; Nursing Care ; Patient Care ; Spouses

PURPOSE: Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle is frequently found in association with a tear of the anterior cruciate liagment (ACL). The purpose of this study was to determine which ligamentous and meniscal tears are associated with kissing contusion. MATERIALS AND METHODS: We retrospectively reviewed the findings depicted by 323 consecutive MR images of the knee and confirmed at arthroscopy. For the diagnosis of disruption, ligaments, medial menisci (MM) and lateral menisci (LM) were evaluated using accepted criteria. We compared the prevalence and location of meniscal and ligamentous tears between group I (44 knees with kissing contusion) and group II (279 knees without kissing contusion). For statistical analysis the chi-square test was used. RESULTS: ACLs were torn in all 44 knees (100%) with kissing contusion, and 78 (28%) of 279 without kissing contusion. There were ten medial collateral ligament (MCL) tears (23%) in group I, and 17 MCL tears (6%), five lateral collateral ligament (LCL) tears (2%) and ten posterior cruciate ligament (PCL) tears (4%) in group II. In group I, meniscal tears were found in 22 MM (50%) and in 19 LM (43%), while in group II, they occurred in 128 MM (46%) and 128 LM (46%). In group I, 17 (77%) of 22 MM tears and 13 (68%) of 19 LM tears were located in the posterior horn, while in group II, the corresponding figures were 97/128 (76%) and 60 of 128 (47%). The differing prevalence of ACL and MCL tears between the groups was statistically significant (p<0.05), but differences in the prevalence and location of meniscal tears were not (p>0.05). CONCLUSION: Although kissing contusion was a highly specific sign of ACL tears, its presence was also significant among MCL tears. There was no signifficant difference in meniscal tears with or without kissing contusion.
Animals ; Arthroscopy ; Collateral Ligaments ; Contusions* ; Diagnosis ; Horns ; Knee ; Lateral Ligament, Ankle ; Ligaments* ; Menisci, Tibial ; Posterior Cruciate Ligament ; Prevalence ; Retrospective Studies

No abstract available.
Neurofibromatoses* ; Neurofibromatosis 1*

BACKGROUND: The smoking rate of Korean male workers is top in the world. To establish the effective smoking cessation strategy, we conducted a study to evaluate the factors associated with smoking and smoking cessation. METHODS: We surveyed 509 male workers in a university hospital about age, marital status, drinking, exercise level and checked their awareness and seriousness for diseases due to smoking, benefits from smoking cessation, motivation derived from massmedi and books and their will to quit smoking by self-administerd questionnaire. RESULTS: The significant factors associated with smoking cessation were higher education (OR=1.85, 95% CI 1.26-2.74), non-religion (OR=0.56, 95% CI 0.38-0.83), drinking (OR=0.40, 95% CI 0.27-0.61), awareness (OR=1.30, 95% CI OR=1.03-3.25) and seriousness (OR=1.29, 95% CI 1.19-1.39) for smoking related disease, benefit (OR=1.21, 95% CI 1.16-1.27), and barrier (OR=0.78, 95% CI 0.74-0.83), motivation (OR=1.21, 95% CI 1.12-1.30), and the will to quit smoking (OR=1.70, 95% CI 1.56-1.85). CONCLUSION: This study suggested that effective smoking cessation program should be based on awareness and seriousness due to smoking related diseases, health benefit and barrier to quitting smoking, company's support, the individual's will to quit and various motivation methods.
Drinking ; Education ; Humans ; Insurance Benefits ; Male* ; Marital Status ; Motivation ; Smoke* ; Smoking Cessation* ; Smoking* ; Surveys and Questionnaires

PURPOSE: Kawasaki disease (KD) is a systemic panvasculitis that causes coronary artery lesions. KD is accompanied by immunoregulatory abnormalities. Nitric oxide (NO) can induce relaxation of blood vessels by activating guanylate cyclase in smooth muscle cells and high levels of NO may result in coronary artery lesions. We investigated tumor necrosis factor (TNF)-alpha and NO production before and after intravenous immunoglobulin (IVIG) therapy to study the roles of NO and TNF-alpha in KD with coronary artery lesions. METHODS: Serum levels of NO and TNF-alpha were measured in 24 patients with KD (group I, eight patients with normal coronary artery; group II, 16 patients with coronary artery lesions) and 23 controls (group III, 13 afebrile controls; group IV, 10 febrile controls). Blood samples from each subject were drawn before and after IVIG therapy and in the convalescent stage. Serum concentrations of NO and TNF-alpha were measured by enzyme linked immuno sorbent assay. RESULTS: The NO levels before IVIG therapy were significantly higher in group II than in group I, group III and group IV. After IVIG therapy the levels of NO were significantly higher in group I and group II than in group III. The TNF-alpha levels before IVIG therapy were significantly higher in group I and group II than in group III. The serum TNF-alpha and NO levels were higher before IVIG therapy and decreased through the convalescent stage in KD patients. In the acute stage of KD patients with coronary artery lesions, serum NO levels significantly correlated with white blood cells (r=043, P< 0.05). CONCLUSION: The serum concentration levels of TNF-alpha and NO were abnormally high in KD patients and NO concentrations were statistically higher in the KD patients with coronary artery abnormalities than those without coronary abnormality during the early stage of the KD. These results suggest NO may be involved in the development of coronary artery lesions.
Blood Vessels ; Coronary Vessels ; Guanylate Cyclase ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Leukocytes ; Mucocutaneous Lymph Node Syndrome* ; Myocytes, Smooth Muscle ; Nitric Oxide* ; Relaxation ; Tumor Necrosis Factor-alpha*

PURPOSE: The use of sealing devices such as Harmonic scalpel and Ligasure is increasing steadily in thyroid surgery. The Harmonic Focus (HF) is an ultrasonic device that enables simultaneous vessel sealing and tissue coagulation, designed for open surgery such as thyroidectomy. The aim of this study is to assess the efficiency and safety of HF use in thyroid surgery compared to Conventional Tying (CT). METHODS: A prospective study was conducted to compare the efficacy of HF versus CT. We evaluated 50 patients who underwent surgery for thyroid tumor at Korea University Anam Hospital. All patients underwent total thyroidectomy with central neck dissection after being randomly allocated into two groups: HF group and CT group. The differences in surgical outcomes and postoperative complications by device use, i.e. group assignment, were statistically analyzed. RESULTS: There were no differences in number of retrieved lymph nodes (P=0.595), number of resected parathyroid glands (P=0.330), immediate postoperative iPTH (P=0.252), length of hospitalization (P=0.375) between HF group and CT group. However, operative time was shorter in HF group than CT group (106.07±20.92 min vs. 136.54±38.24 min, P=0.046). Postoperative complications of wound infection, seroma, hematoma, chyle leakage, vocal cord palsy, and hypoparathyroidism did not differ between groups. CONCLUSION: HF is a safe, effective, and time-saving technique; outcomes are comparable with CT. Both intraoperative and postoperative variables were similar between groups. Future larger studies are warranted to further investigate the effect on postoperative complications.
Chyle ; Hematoma ; Hospitalization ; Humans ; Hypoparathyroidism ; Korea ; Lymph Nodes ; Neck Dissection* ; Neck* ; Operative Time ; Parathyroid Glands ; Postoperative Complications ; Prospective Studies ; Seroma ; Thyroid Gland ; Thyroidectomy* ; Ultrasonics ; Vocal Cord Paralysis ; Wound Infection

BACKGROUND: Nationwide evaluation of physicians' smoking rate may be helpful to predict future trend of smoking in a general population. Thus, we investigated physicians' smoking rate and their habits in Korea. METHODS: Ten percent of physicians among the registered members of the Korean Medical Association were chosen by stratified random sampling and a mail questionnaire survey was conducted in 2000. Of the 2,977 physicians to whom the questionnaires were delivered, 1,248 (41.9%) responded. RESULTS: Overall smoking rate among Korean doctors was 29.9%. Smoking rate of males was 34.9% and that of females was 2.3%. In the current smokers, the most frequently reported age when they had begun smoking were 15~20 years (60.3%), the majority of daily smoking amount was less than or equal to 1 pack (92.5%), and those who were planning to quit smoking within 1 month were 11.9%. In the ex-smokers, the most frequently reported age when they had begun smoking were in their 20s (67.7%) and the most frequently reported age when they had stopped smoking were in their 30s (38.0%). CONCLUSION: The smoking rate of Korean physicians was estimated to be less than that of the general Korean population, but higher than that of physicians in major developed countries. More efforts to lower smoking rate of physicians and regular follow up is needed.
Developed Countries ; Female ; Humans ; Korea* ; Male ; Postal Service* ; Prevalence* ; Smoke* ; Smoking* ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to analyze the types of attitudes of nursing students in Korea toward bucket lists. METHODS: The Q-methodology, which provides a method for analyzing the subjectivity of each item was used. From each of the 37 subjects, 34 selected Q-statements were classified into the shape of a normal distribution, using a 9-point scale. The collected data were analyzed using a QUANL PC program. RESULTS: Four types of attitudes toward the bucket list of subjects were identified in Korean nursing students. Typeis a pursuit of money type, Type II is a pursuit of relationship type, Type III is a pursuit of self-centered type, and Type is a pursuit of others-centered type. CONCLUSION: The results of this study indicate that different approaches toward educational programs for students in the human service area are recommended based on the four types of nursing students' attitudes toward the bucket list.
Humans ; Korea ; Nursing ; Students, Nursing*

PURPOSE: Recently, different results about factors affecting accurate quantitation of 24-hr urinary protein(24UP) amount using spot urine protein/creatinine ratio(PCR) have been reported. The current study was designed to evaluate correlation between 24UP amounts and PCR in children, and the effect of 24UP amounts, age, sex, and glomerular filtration rate(GFR) on this correlation. METHODS: Among 94 patients who visited the department of pediatrics in Busan Paik Hospital from March 2002 to August 2002, 68 patients whose urinary creatinine excretion was > or = 15 mg/kg/day were included in this study. All the patients were divided into I, II/A, B group(I : 24UP < 500 mg/day, II : 24UP > or = 500 mg/day, A : < 10 years of age, B : > or = 10 years of age). Pearson correlation analysis was performed between 24UP and PCR to evaluate the relationship. We defined fractional difference between 24UP and PCR, and then performed multiple regression analysis with 24UP amount, age, GFR and fractional difference. RESULTS: There was a strong positive linear correlation between 24UP and PCR(R=0.936, P < 0.0001) in all patients, and the correlation was also good in each group. Using PCR cutoff values of 0.5, the PCR provided high sensitivity, specificity, positive and negative predictive value in predicting 24UP amount > or = 500 mg. The factors affecting accurate quantitation of proteinuria using spot urine PCR was age, not 24UP amount, GFR or sex. CONCLUSION: Spot urine PCR is a useful test but has limitations in predicting 24UP amount. Therefore, it should be used only as screening method. Age-adjusted PCR cutoff values may be necessary to predict 24UP amount in children with proteinuria.
Busan ; Child* ; Creatinine ; Filtration ; Humans ; Mass Screening ; Pediatrics ; Polymerase Chain Reaction ; Proteinuria* ; Sensitivity and Specificity