BACKGROUND: Pulmonary complications including pneumonia and pulmonary edema frequently develop in critically ill surgical patients. Lung ultrasound (LUS) is increasingly used as a powerful diagnostic tool for pulmonary complications. The purpose of this study was to report how LUS is used in a surgical intensive care unit (ICU). METHODS: This study retrospectively reviewed the medical records of 67 patients who underwent LUS in surgical ICU between May 2016 and December 2016. RESULTS: The indication for LUS included hypoxemia (n = 44, 65.7%), abnormal chest radiographs without hypoxemia (n = 17, 25.4%), fever without both hypoxemia and abnormal chest radiographs (n = 4, 6.0%), and difficult weaning (n = 2, 3.0%). Among 67 patients, 55 patients were diagnosed with pulmonary edema (n = 27, 41.8%), pneumonia (n = 20, 29.9%), diffuse interstitial pattern with anterior consolidation (n = 6, 10.9%), pneumothorax with effusion (n = 1, 1.5%), and diaphragm dysfunction (n = 1, 1.5%), respectively, via LUS. LUS results did not indicate lung complications for 12 patients. Based on the location of space opacification on the chest radiographs, among 45 patients with bilateral abnormality and normal findings, three (6.7%) and two (4.4%) patients were finally diagnosed with pneumonia and atelectasis, respectively. Furthermore, among 34 patients with unilateral abnormality and normal findings, two patients (5.9%) were finally diagnosed with pulmonary edema. There were 27 patients who were initially diagnosed with pulmonary edema via LUS. This diagnosis was later confirmed by other tests. There were 20 patients who were initially diagnosed with pneumonia via LUS. Among them, 16 and 4 patients were finally diagnosed with pneumonia and atelectasis, respectively. CONCLUSIONS: LUS is useful to detect pulmonary complications including pulmonary edema and pneumonia in surgically ill patients.
Anoxia ; Critical Care* ; Critical Illness ; Diagnosis ; Diaphragm ; Fever ; Humans ; Lung* ; Medical Records ; Pneumonia ; Pneumothorax ; Pulmonary Atelectasis ; Pulmonary Edema ; Radiography, Thoracic ; Retrospective Studies ; Ultrasonography* ; Weaning

PURPOSE: The purpose of this study was to construct the clear definition of the concept 'self-reliance' among persons with psychiatric disabilities. METHODS: A hybrid model (comparative analysis between literature review findings and actual interview data) was employed to extract essential components of 'self-reliance' and develop its clear definition among those subjects. RESULTS: Self-reliance appeared to have complex nature and consist of multi-dimensional meaning units with 4 different levels (including 8 attributes and 21 indicators). 4 different levels of dimensions and their 8 attributes are suggested as follows: 1) Personal dimension (increasing insight, improving motivation for recovery); 2) Procedural dimension (encouraging empowerment and overcoming internalized stigma, self-esteem); 3) Institutional dimension (utilizing social and government support, formulating social-networks); 4) Consequential dimension (financial independence, planning for independent housing, self-determination). CONCLUSION: The findings of this study will contribute to developing valid measurements to examine self-reliance and establishing nursing interventions aiming at increasing self-reliance in persons with psychiatric disabilities.
Housing ; Humans ; Independent Living ; Motivation ; Nursing ; Power (Psychology)

No abstract available.
Child* ; Humans ; Reye Syndrome*

No abstract available.
Hemolytic-Uremic Syndrome*

To evaluate the diagnostic accuracy of two-dimensional echocardiogrphy(2-D echo) in ventricular septal defect, location and size of the defects, estimated right ventricular systolic pressure and associated cardiac anomaly were compared to the operative findings in 139 children operated for correction of ventricular septal defect at Severance Hospital from Jan. 1983 to June 1987. In addition, postoperative complications and mortality cases were anlysed. The following results were obtained; 1) Perimembranous defects were 82 cases(66.1%), subarterial infundibular defects 33 cases(26.6%), and muscular defect was found in only 1 case(0.8%). The accuracy of 2-D echo in localizing the defects was 84.2%. 2) In 79.2% of the patients, the defects were moderate to large in size, and actual size measured at operation was larger than that obtained by echocardography in general. 3) The estimated right ventricular systolic pressure was correlated(r=0.650) with that measured at the operating field. 4) Combined cardiac anomalies were patent ductus arteriosus(22 cases), atrial septal defect(3 cases), valvular pulmonic stenosis(2 cases) and interventricular septal aneurysm(2 cases). The sensitivity of 2-D echo in detecting these anomalies was 65.5% and the specificity was 96.4%. 5) Among 32 patients who had postoperative complications, in two thirds, there were pulmonary complication including lung atelectasis(16 cases), pleural effusion(5 cases)and pneumonia(5 cases). 6) Operative mortality was 2.9%(4 cases). The causes of death were low cardiac output state due to left ventricular myocardial failure in 3 patients and respiratory failure from asphyxia in one case. In conclusion, with close cooperation with cardiac surgeons, there will be few problems in diagnosing and operating patients with ventricular septal defect on the basis of two-dimensional echocardiographic findings without invasive procedures, such as cardiac catheterization, even with pulmonary hypertension, unless Eisenmenger syndrome is complicated.
Asphyxia ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output, Low ; Catheterization* ; Catheters* ; Cause of Death ; Child* ; Echocardiography* ; Eisenmenger Complex ; Heart Failure ; Heart Septal Defects, Ventricular* ; Humans ; Hypertension, Pulmonary ; Lung ; Mortality ; Postoperative Complications ; Respiratory Insufficiency ; Sensitivity and Specificity

BACKGROUND: This study was aimed to elucidate the effect of thiopental anesthesia on circulatory response to hemorrhage in rats by power spectral analysis of heart rate and blood pressure variability. METHODS: Sixteen male Sprague-Dawley rats weighing 350~475 g were divided into thiopental (50 mg/kg, ip)-anesthetized (T, n=10) and conscious (C, n=6) groups. Hemorrhage was induced with a withdrawal pump from the femoral artery at 3 ml/kg/min for 5 min. Arterial pressure was measured with a pressure transducer connected to the contralateral femoral artery for 5 min before, during and after hemorrhage. The blood pressure signal digitized at 500 Hz through a data acquisition system was analyzed with fast Fourier transform algorithm to yield power spectra of sytolic (SP) and diastolic (DP) blood pressure and instantaneous heart rate (HR). Powers of very low frequency (VLF, 0.02~0.26 Hz), low frequency (LF, 0.26~0.75 Hz) and high frequency (HF, 0.75~5.00 Hz) band were expressed as percent of total power. RESULTS: Before Hemorrhage blood pressure was lower in T (113 6/83 6 mmHg) than in C (157 4/101 2) rats, but was not changed by hemorrhage in both groups. Before Hemorrhage HR was lower in T (331 22 beats/min) than in C (378 27) rats. HR was significantly increased to 412 26 beats/min in C, but was not changed in T during hemorrhage. Total powers of Before Hemorrhage blood pressure and HR variability were lower in T than in C. During hemorrhage, total power of blood pressure variability tended to increase in both groups, and that of DP was significantly increased during hemorrhage in T. Total power of HR was significantly increased in C, but was not changed in T. T rats showed lower LF and higher HF power of blood pressure, and lower VLF and LF and higher HF power of HR than C rats. During hemorrhage, both groups showed no significant change in spectral distribution of HR power, except for a significant increase in LF of HR after hemorrhage in C. Spectral distribution of blood pressure power was not changed by hemorrhage in C. In T rats, VLF of DP was significantly increased and HF of DP was decreased during hemorrhage. CONCLUSIONS: It suggests that autonomic activity, especially cardiac sympathetic activity is increased in response to hemorrhage in C. Thiopental anesthesia depresses overall autonomic activity, especially sympathetic activity, and vasomotor tone. Hemorrhage under thiopental anesthesia induces depression of baroreceptor reflex activity, while increased levels of vasoconstrictor hormones help to maintain the blood pressure.
Anesthesia ; Animals ; Arterial Pressure ; Baroreflex ; Blood Pressure* ; Depression ; Femoral Artery ; Fourier Analysis ; Heart Rate* ; Heart* ; Hemorrhage* ; Humans ; Male ; Rats* ; Rats, Sprague-Dawley ; Thiopental ; Transducers, Pressure

BACKGROUND: Contact immunotherapy using diphenylcyclopropenone (DPCP) has been used in the treatment of alopecia and warts. DPCP seemed to be a promising agent for viral disease including molluscum contagiosum (MCI). OBJECTIVE: The purpose of this study was to evaluate the effect of DPCP immunotherapy on MC in children. METHODS: Twenty three patients with multiple lesion of MC were treated with DPCP immunotherapy. RESULTS: Twelve patients (52.2%) showed cure, and eleven patients (47.8%) showed treatment failure. No severe side effects were seen. CONCLUSION: DPCP immunotherapy may be an effective treatment in children with MC without serious side effects.
Alopecia ; Child ; Humans ; Immunotherapy* ; Molluscum Contagiosum* ; Treatment Failure ; Virus Diseases ; Warts

Solar urticaria is a fairly uncommon but Well recognized clinical entity characterized by erythema and wheal with itching immediately following exposure to sunlight or artifical radiation. A 33-year-old female had a six-year duration of urticaria, tightness of chest and dizziness that appeared within 15 minutes of exposure to sunlight. The action spectrum of this patient was between 320 and 400nm and the passive and reverse passive transfer test were negative. Solar urticaria of our patient appeared to belong to type g in the classification of Harber et al(1963). The patient was treated with antihistamines and repeated exposure to sunlight for inducing tolerance. After 3 months of the treatment, the symptoms did not appear even after 3 hours of exposure to sunlight.
Adult ; Classification ; Dizziness ; Erythema ; Female ; Histamine Antagonists ; Humans ; Intradermal Tests ; Pruritus ; Sunlight ; Thorax ; Urticaria*

Most ectopic pregnancies occur in the fallopian tubes. There have been numerous theories to explain the occurrence of ectopic pregnancy in fallopian tubes. The most commonly held view is that the passage of the fertilized ovum through the fallopian tube is delayed or hindered by chronic inflammation and its sequelae. We designed a study to evaluate the details of histopathologic changes and the location of implantation and how they relate to the clinical history. 182 fallopian tube specimens from patients who had undergone total or partial salpingectomy were examined. A high incidence of non-specific inflammation of plicae and wall of tube (31.9%) and salpingitis isthmica nodosa (12.6%) were observed. Other associated findings included acute salpingitis, complex plicae or complex hyperplasia of tubal epithelium, fibrous adhesion with ovary, endometriosis, and calcification. History of previous ectopic tubal pregnancy was found in 8 cases. The cases with serum beta-HCG value above 2,500 I.U./L (group I, n=97) were more frequently noted in those exhibiting myosalpingeal invasion of trophoblast (67 cases) than in those without invasion (30 cases). Of the 182 tubal pregnancies, 117 (64.3%) cases were found in the ampulla and 47 (25.8%) cases in isthmic location. In 117 ampullary pregnancies, the products of conception were found intraluminally in 71 cases (60.7%), and extraluminally in 34 (29.1%) cases, of which the products of conception were found entirely extraluminal. The products of conception, found both within and outside the tubal lumen, were found in 12 cases (10.2%). Of 47 tubes with isthmic pregnancies, 33 cases were intraluminal (70.2%), 12 cases were extraluminal (25.5%), and two cases were mixed (4.3%). In conclusion, significant histopathologic abnormalities accompany a majority of ectopic tubal pregnancy, and myosalpingeal invasion of trophoblast is correlated with high serum beta-HCG. Thus, it is necessary to confirm not only the ectopic placental tissue but also the accompanying details of the other histopathologic findings or the pathologic evaluation of ectopic tubal pregnancy.
Endometriosis ; Epithelium ; Fallopian Tubes ; Female ; Fertilization ; Humans ; Hyperplasia ; Incidence ; Inflammation ; Ovary ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Tubal* ; Salpingectomy ; Salpingitis ; Trophoblasts ; Zygote

We observed 2 cases of multiple trichoepithelioma, which occured in 25-year- old male and 20-year-old female. They visited our department for multiple skin rashes on the face of 8 years duration in male and 7 years' duration in female patient. Both of them have similar skin lesions characterized by multiplel waxy gshiny, skin colored, firm papules scattered on the nasolabial folds, both eyelids and forehead. Each one of them has a history of similar skin lesions in the family. Literatures are briefly reviewed for discussion of clinical and histopathologicl findings in this disease.
Exanthema ; Eyelids ; Female ; Forehead ; Humans ; Male ; Nasolabial Fold ; Skin ; Young Adult