A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte* ; Pneumonia ; Pneumonia, Aspiration* ; Shock, Septic ; Spine ; Vomiting

No abstract available.
Ciliary Motility Disorders*

The purpose of this study is to investigate factors related to the intent of using home nursing of chronic disease patients who got out of a university hospital. For the purpose. the study selected 153 patients who were hospitalized and left K university hospital with diagnoses of cancer. hypertension. diabetes and cerebral vascular accident and ordered to be discharged and performed interviews with them and surveys on their medical records to obtain the following results. For this study a direct-interview survey and medical record review was conducted from June 28 to Aug. 30. 1998. The frequency and mean values were computed to find the characteristics of the study subjects. and chi-test. t-test. factor analysis and multiple logistic regession analysis were applied for the analysis of the data. The following results were obtained. 1) When characteristics of the subjects were examined. men and women occupied for 58.8 % and 41.2 %. respectively. The subjects were 41.3 years old in average and had the monthly average earning of 0.99 million won or below. which was the most out of the total subjects at 34.6 %. Among the total. 87.6% resided in cities and 12.4 in counties. The most left the hospital with diagnosis of cancer at 51.6 %. followed by hypertension at 24.2%. diabetes at 13.7% and cerebral vascular accident at 7.2%. 2) 93.5% of the selected patients had the intent of using home nursing and 6.5%. didn't. Among those patients having the intent. 85.6% had the intent of paying for home nursing and 14.4%. didn't. The subjects expected that the nursing would be paid 9.143 won in average and 47.7 % of them preferred national authorities as the mam servers. 86.3% of the subjects thought that home nursing business had the main advantage of making it possible to learn nursing methods at home and thereby contributing to improving the ability of patients and their facilities to solve health problems. 3) Relations between the intent of use and characteristics of the subjects such as demography-related social. home environment. disease and physical function characteristics did not show statistically significant differences among one another. Compared to those who had no intent of using home nursing. the group having the intent had more cases of male patients. the age of 39 or below. residence in cities. 5 family members or more, no existence of home nursing servers, leaving the hospital from a non-hospitalized building, disease development for five months or below, hospitalization for ten days or more, non-hospitalization within the recent one month, two times or over of hospitalization, leaving the hospital with no demand of special treatment, operation underwent, poor results of treatment, leaving the hospital with demand of rehabilitation services, physical disablement and high evaluation point of daily life. 4) Among those patients having the intent of using home nursing, 47.6% demanded technical nursing and 55.9%, supportive nursing. As technical nursing, 'inject into a blood vessel' and 'treat pustule and teach basic prevention methods occupied for 57.4%, respectively, topping the list. Among demands of supportive nursing, 'observe patients' status and refer them to hospitals or community resources as available, if necessary' was the most with percentage point of 59.5. Regarding the intent of paying for home nursing, 39.2% of those patients wishing to use the nursing responded paying for technical services and 20.2, supportive services. In detail. 70.0% wanted to pay for a service stated as 'inject into a blood vessel' , highest among the former services and 30.7%, a service referred to as 'teaching exercises needed to make the body of patients move', highest among the latter. When this was analyzed in terms of a relation between the need(the need for home nursing) and the demand(the intent of paying for home nursing), The rate of the need to the demand was found two or three times higher in technical nursing(0.82) than in supportive nursing(0.35). In aspects of technical nursing, muscle injection(0.26, the 1st rank) was highest in the rate while among aspects of supportive nursing. a service referred to as 'teach exercises needed for making patients move their bodies normally' (0.58, the 1st rank). 5) factors I(satisfaction with hospital services), II(recognition of disease state), III(economy) and IV(period of disease) occupied for 34.4, 13.8, 11.9 and 9.2 percents, respectively among factors related to the intent by the subjects of using home nursing, totaled 59.3%. In conclusion, most of chronic disease patients have the intent of using hospital-based home nursing and satisfaction with hospital services is a factor affecting the intent most. Thus a post-management system is needed to continue providing health management to those patients after they leave the hospital. Further, supportive services should be provided in order that those who are satisfied with hospital services return to their community and live their independent lives. Based on these results, the researcher would make the following recommendation. 1) Because home nursing becomes more and more needed due to a sharp increase in chronic disease patients and elderly people, related rules and regulations should be made and implemented. 2) Hospital nurses specializing in home nursing should be cultivated.
Aged ; Chronic Disease ; Commerce ; Diagnosis ; Exercise ; Female ; Home Nursing* ; Hospitalization ; Humans ; Hypertension ; Male ; Medical Records ; Nursing ; Rehabilitation ; Social Control, Formal

BACKGROUND: Echocardiographically detected left ventricular(LV) hypertrophy is a risk factor for cardiovascular morbidity and mortality. A better understanding of the determinants of LV mass may aid in strategies directed toward the promary and secondary prevention of LV hypertrophy and its consequences. Previous studies have reported that male gender, arterial blood pressure(BP), obesity, age, aortic valvular stenosis, dietary sodium, endocrine factors, and physical activity are positively correlated with LV mass. Of these determinants male gender, hypertension, and obesity are well known but age and blood pressure in healthy adults are controversial. To assess the determinants of LV mass, the relation of 2-dimensional(2D) echocardiographically determined LV mass to body mass inedx(BMI), age, sex, casual BP, and 24 hour ambulatory blood pressure(ABP : systolic, diastolic, and mean BP of 24 hour, day-time, and night-time) was examined in healthy adults. METHODS: The study population consisted of 200 healthy adults who were normotensive, nonobese, and had no evidence of cardiovascular disease(range in age from 20 to 69 years, five decades, 20 men and 20 women per each decade). LV mass was derived from area length method measurements obtained by 2D echocardiography and corrected for height. ABP monitoring was performend over 24 hour(divided into day-time(6am-10pm) and night-time(10pm-6am)periods) with 30 minute inervals. RESULTS: 1) BMI was significantly and independently related to LV mass corrected for height (p<0.001, partial R2=0.31 in men and 0.43 in women). An increase of BMI by 1 kg/m2increased LV mass corrected for height by 1.9g/m in men and 2.0g/m in women. 2) Age was significantly and independently related to LV mass corrected for height(p<0.001, partial R2=0.15 in men and 0.17 in women). The increments of Lv mass corrected for height per decade were 2.1 g/m in men and 3.4 g/m in women. 3) Gender was significantly and independently related to LV mass corrected for height(p<0.001, partial R2=0.12), which was greater in men than in women by 6.34g/m. 4) Casual Bp and 24 hour ABP were not significantly associated with LV mass corrected for height in total population and women, and 24 hour systolic BP was significantly related to LV mass corrected for height only in men(p<0.001) with weak partial R2(0.05). CONCLUSION: BMI, age, and male gender were statistically significant and independent correlates of LV mass corrected for height(p<0.001). Maintenance of ideal body weight and normal BP, weight reduction in obese persons and BP control inhypertensive patients may contribute to the primary and secondary prevention of LV hypertrophy and its sequalae.
Adult* ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory* ; Constriction, Pathologic ; Echocardiography* ; Female ; Humans ; Hypertension ; Hypertrophy ; Ideal Body Weight ; Male ; Mortality ; Motor Activity ; Obesity ; Risk Factors ; Secondary Prevention ; Sodium, Dietary ; Weight Loss

In connective tissue diseases, autoantibodies cause pulmonary interstitial inflammation and fibrosis, and patients require treatment with an immunosuppressive agent such as a steroid. Dermatomyositis is an incurable, uncommon form of connective tissue disease that occasionally causes diffuse pulmonary inflammation leading to acute severe respiratory failure. In such cases, the prognosis is very poor despite treatment with high-dose steroid. In the present case, a 46-year-old man was admitted to our hospital with dyspnea. He was diagnosed with dermatomyositis combined with cryptogenic organizing pneumonia (COP) with respiratory failure and underwent treatment with steroid and an immunosuppressive agent, but the COP was not improved. However, the respiratory failure did improve after treatment with intravenous immunoglobulin, which therefore can be considered a treatment option in cases where steroids and immunosuppressive agents are ineffective.
Autoantibodies ; Connective Tissue Diseases ; Cryptogenic Organizing Pneumonia* ; Dermatomyositis* ; Dyspnea ; Fibrosis ; Humans ; Immunoglobulins* ; Immunosuppressive Agents ; Inflammation ; Lung Diseases, Interstitial ; Middle Aged ; Pneumonia ; Prognosis ; Respiratory Insufficiency ; Steroids

BACKGROUND: Germline mutations in the breast cancer-associated genes BRCA1 and BRCA2 confer susceptibility and a lifetime risk of breast. Several morphological and clinical features have been attributed to hereditary tumors. However, in sporadic breast cancer, the interrelationship between the loss of heterozygosity (LOH) of these loci and clinical features remains to be fully elucidated. METHODS: Microdissected paraffin-embedded tissue blocks of 48 cases of surgically resected breast carcinoma were investigated to identify the LOH of BRCA1 and BRCA2 using microsatellite markers. RESULTS: Of 48 cases, 22 (45.9%) exhibited LOH at BRCA1 locus while in 29 out of 48 (60.4%) cases LOH was observed for the BRCA2 region. There was no significant correlation between LOH at BRCA1/2 and the patient's age, tumor size, histologic grade or lymph node metastasis. When comparing the frequency of LOH with the expression of several prognostic factors, such as p53, c-erb B2 protein, estrogen and progesterone receptor using immunohistochemical stain, there was only correlation with LOH at BRCA2 and the progesterone receptor. CONCLUSIONS: Our results suggest that allelic deletion play a role to the development of sporadic breast cancers.
Breast Neoplasms* ; Breast* ; Estrogens ; Germ-Line Mutation ; Loss of Heterozygosity* ; Lymph Nodes ; Microsatellite Repeats ; Neoplasm Metastasis ; Paraffin* ; Receptors, Progesterone

OBJECTIVE: To find out general characteristics, common problems, outcomes of delivery of unmarried mothers and related social factors, and to provide basic information based on the results in order to change social systems and to have a correct understanding of unmarried mothers. METHODS: We studied 196 unmarried mothers who delivered from Jan. 2003 to Aug. 2004. All data were collected by survey whose groups were divided into three by ages, and they were analyzed by Fisher's exact test obstetrically and socially. It verified 95% significant level. RESULTS: Cesarean section rate was 14.3% which is remarkably lower than married mothers. However, it is getting higher (p=0.003) as they are older, and the rate of group of 30s is similar to that of married mothers. Also, the average birth weight of unmarried mothers' babies is 3,056 gm and it is similar to that of married mothers. They took prenatal care only 3.27 times and 22% of them did not commence it until the 3rd trimester. Fifty seven percent drank alcohols, 51% smoked, and 49% used drugs during pregnancy. Most unmarried mothers who took this survey had a lower level and economic status. After delivery, 16.3% of them raise their babies and 83.7% of them had their babies adopted through welfare facilities. CONCLUSION: We conclude that it is necessary to have a social system, welfare facilities, and financial supports that educate contraceptive measures to potential unmarried mothers, let them recognize their situations, and protect them.
Alcohols ; Birth Weight ; Cesarean Section ; Female ; Financial Support ; Humans ; Illegitimacy* ; Linear Energy Transfer ; Mothers ; Pregnancy* ; Prenatal Care ; Single Person* ; Smoke ; Social Welfare*

In this immunohistochemical study we applied a monoclonal antibody(mAb) to evaluate the expression pattern of lymphocyte functionassociated antigen 3(LFA-3) in rabbit`s corneas before and after intracorneal injection of Candida albicans. Ten right eyes were induced to get immunocompromized cornea with subconjunctival injection of 2mg of dexamethasone once a day for 3 days(group I), and 10 left eyes had normal cornea without subconjunctival injection of dexamethazone(group II). Each 2 corneas in both group I and II were resected at 3, 12, 24 and 72 hours after intracorneal injection of C. albicans. Each 2 corneas without intracorneal injection of C. albicans in both groups were used as a control. The results were as follows: LFA-3 was expressed weakly on corneal epithlium in control of group I and group II. Expression of LFA-3 on vascular endothelium of group II was somewhat stronger than that of group I, LFA-3 was expressed moderately on vascular endothelium, and was detected on corneal stroma at 3 hors after intracorneal injection in both groups. Expression of LFA-3 on corneal stroma was slightly increased in both group II, and markedly increased in group I at 12 hours after intracorneal injection. Group II showed slightly increased LFA-3 expression on corneal and II to be expressed on corneal endothelium and inflammatory cells at 24 hours after injection. Its expression on corneal epithelium, stroma and endothelium was more increased in group II than in group I at that time. Group I showed moderate LFA-3 expression on corneal epithelium, corneal endothelium and inflammatory cells, and strong expression on corneal stroma and vascular endothelium at 72 hours after infection. Otherwise, LFA-3 expression in group II was weak to moderate n corneal epithelium, corneal endothelium and inflammatory cell, and moderate on corneal stroma and vascular endothelium. In this study, it was found that expression of LFA-3 in group I was weaker than that in group II in control and at 3 hours after intracorneal injection of C. albicans, but group I showed more strong LFA-3 expression than group II after 12 hours of intracorneal injection.
Antigens, CD58 ; Candida albicans* ; Candida* ; Cornea ; Corneal Stroma ; Dexamethasone ; Endothelium ; Endothelium, Corneal ; Endothelium, Vascular ; Epithelium, Corneal ; Lymphocytes ; Rabbits*

An obese parturient can pose considerable physiologic and technical chalenges to an anesthesiologist. The combined pulmonary changes of pregnancy and obesity commonly make for hypoventilation & hypoxemia because they have both a reduced functional residual capacity and an increased oxygen consumption. The cardiovascular system is also stressed by obesity and pregnancy; both conditions contribute to increased cardiac work. Hypotension is frequently associated with spinal anesthesia because of aortocaval compression by the enlarged uterus and sympathetic blockade. In general anesthesia, obesity is an important risk factor for difficult intubation. Pulmonary aspiration of gastric contents is another significant risk of general anesthesia. Obese parturients are at high risk for developing hypoxia during the induction of anesthesia. We successfully managed the first Cesarean section of a morbidly obese parturient (25 years old, BMI = 54.19 kg/m2) with pregnancy induced hypertension using spinal anesthesia. Then, 1 year later we also successfully managed the second Cesarean section in the same patient (26 years old, BMI = 54.95 kg/m2) using general anesthesia. We restress the importance of anesthetic management of morbidly obese parturients in this case report.
Anesthesia ; Anesthesia, General ; Anesthesia, Spinal ; Anoxia ; Cardiovascular System ; Cesarean Section* ; Female ; Functional Residual Capacity ; Humans ; Hypertension, Pregnancy-Induced ; Hypotension ; Hypoventilation ; Intubation ; Obesity ; Oxygen Consumption ; Pregnancy ; Risk Factors ; Uterus

OBJECIVE: Although incidence of the cervical cancer has been very high, it is possible to detect the early cervical cancer with screening methods. Among the screening methods of cervical cancer, Papanicolaou smear has lower sensitivity and higher false negative rate. The goal of this study is to evaluate the usefulness of cervicography in cervical cancer screening. METHODS: The data of Papanicolaou smear and cervigram has been obtained from 292 patients. The age range varied between 20 and 78 years with the average age of 42. Histologic specimens were obtained from patients whose abnormalities were detected by either Papanicolaou smear or cervigram. A total of 101 patients received a biopsy. We calculated sensitivity, specificity, positive predictive values, negative predictive values, false negative rates and false positive rates. RESULTS: Results for Papanicolaou smear are as follows; sensitivity, 60.8%, specificity, 93.4%, positive predictive values, 66.0%, negative predictive values, 91.8%, false negative rates, 39.2% and false positive rates, 6.6%. In cervicography, sensitivity, 70.1%, specificity, 85.5%, positive predictive values, 56.3%, negative predictive values, 94.5%, false negative rates, 23.5% and false positive rates, 11.6%. Results for the combined methods are sensitivity with 82.4%, specificity with 92.5%, positive predictive values with 51.9%, negative predictive values with 97.0%, false negative rates with 11.8% and false positive rates with 16.2%. CONCLUSION: Cervicography is an effective method to screen cervical cancer. When cervicography is used with Papanicolaou smear, the detection rate of cervical cancer will be increased.
Biopsy ; Humans ; Incidence ; Mass Screening* ; Papanicolaou Test ; Sensitivity and Specificity ; Uterine Cervical Neoplasms*