No abstract available.
Hemiplegia* ; Humans ; Stroke ; Upper Extremity*

The authors report a case of monostotic eosinophilic granuloma which occured in the skull. A 37 year-old woman was presented with headache and soft mass in the occipital region. Plain skull X-ray showed a "punched out" osteolytic lesion in the right paramedian posterior parietal bone. Computed tomography shows a soft tissue mass and irregular bone destruction in corresponding region. On magnetic resonance image, the mass was of high signal intensity, with subgaleal extension and looks like a shirt stud or "collar button" on T2-weighted image. Total excision of the tumor and postoperative radiotherapy(1000cGy) were performed. The woman had no headache complains nor showed any focal neurologic deficit during the six months follow-up period. We report a case of monostotic eosinophilic granuloma of the skull with review of the pertinent literatures.
Adult ; Eosinophilic Granuloma* ; Eosinophils* ; Female ; Follow-Up Studies ; Headache ; Humans ; Neurologic Manifestations ; Parietal Bone ; Skull*

The auther studied 54 lumbar spondylolisthesis patients diagnosed and treated with transpedicular screw fixation and bony fusion at our Hosptial between January 1990 and December 1994, and analysed the outcome. The results may be summarized as follows: 1) Of the 54 cases, 17 were degenerative spondylolisthesis and 37 were spondylolytic spondylolisthesis. Occurrence peaked during the fifth and sixth decades. 2) Posterolateral fusion(P.L.F) was performed in 37 cases and posterior lumbar interbody fusion(P.L.I.F) in eight ; P.L.F and P.L.I.F in combination was performed in nine cases. The mean follow-up period was 25 months. 3) In no patients was significant neurologic injury or functional root loss seen. Complications included two instrument failures and one wound infection. 4) Radiologic and clinical outcome was better in degenerative than in spondylolitic spondylolisthesis. 5) The radiologic and clinical outcome of bony fusion types P.L.F and P.L.I.F was the same. 6) The surgical result as evaluated by Mc.Nab's criteria was satisfactory in 81% of patients.
Follow-Up Studies ; Humans ; Spine* ; Spondylolisthesis* ; Wound Infection

To determine whether the relative proportion of stromal and epithelial hyperplasia is related to the development of symptomatic benign prostatic hyperplasia, we measured the percentage of stroma and gland by quantitative morphometric analysis in the prostate adenomas from men with symptomatic and asymptomatic BPH. Prostate adenomas were obtained from 9 men with asymptomatic BPH undergoing cysto-prostatectomy for invasive transitional cell carcinoma of the bladder (group 1), 15 with symptomatic BPH undergoing transurethral resection of the prostate and 5 with symptomatic BPH undergoing open prostatectomy( <60g : group 2a), and 15 with symptomatic BPH undergoing open prostatectomy( >= 60g: group 2b). The results obtained were as follows. 1. The prostate adenomas from group 1, 2a and 2b contained 57.1 %, 68.2% and 68.8% of stroma and 19.69t, 14.3% and 13.2% of epithelium and 23.3%, 17.5% and 18.0% of glandular lumen, respectively. The difference in percentage of stroma, epithelium and glandular lumen in the prostate adenoma from men with symptomatic and asymptomatic BPH were statistically significant(P <0.05). 2. The prostate adenomas from 24 men with modified Boyarsky obstructive symptom scoring over 10 were compared with 11 men with scores less than 10. The results were 68.2% vs. 69.3%, 13.8% vs. 13.5% and 18.0% vs. 17.2% of stroma, epithelium and glandular lumen, respectively ( P>0.1). 3. The prostate adenomas from 19 men with modified Boyarsky irritative symptom scoring over 7 were compared with 16 men with scores less than 7. The results were 67.6% vs. 69.9%, l3.8% vs. 14.1% and l8.0% vs. 16.2% of stroma, epithelium and glandular lumen, respectively ( P>0.1) . In conclusion, the prostate adenomas from men with symptomatic BPH were composed of more proportion of stroma and lesser proportion of epithelium and glandular lumen than those from men with symptomatic BPH. The histological composition of prostate adenomas were not related to the severity of obstructive or irritative symptom.
Adenoma ; Carcinoma, Transitional Cell ; Epithelium ; Humans ; Hyperplasia ; Male ; Prostate ; Prostatic Hyperplasia* ; Urinary Bladder

PURPOSE: The purpose of this research was to evaluate the application of the Problem-Based Learning(PBL) in nursing with regard to the learning process and learning outcomes. METHOD: PBL modules were provided to the students so that they could identify the nursing problems related to nutrition, regulation, and elimination, and implement appropriate nursing interventions according to the problems. PBL was also used to develop ability to use self-evaluation for nursing intervention outcomes. The modules were developed by the authors for the course, Nursing 1(3 credits) at Y university, and used during one semester, March to June 2003. Evaluation of the learning process and learning outcomes was done by self-report questionnaires and a semi-structured self-report developed by the authors. RESULT: The PBL evaluation included role of the facilitators, group work process, and self-directed learning attitude. The students evaluated the facilitator's role positively in fostering positive interactions and cooperative study among students and stimulating students to apply various problem-solving strategies. Students evaluated their own group work performances as a good opportunity to improve their group work participation, contribution, cooperation, and leadership through the PBL session. Their responsibility for their own learning and develop self-directed learning attitudes to connect present learning to long-term goals. CONCLUSION: Critical thinking, problem solving skills, self-directed learning and group work accomplishments in undergraduate student nurses were fostered and improved through the PBL program.
Diagnostic Self Evaluation ; Foster Home Care ; Humans ; Leadership ; Learning ; Nursing* ; Problem Solving ; Problem-Based Learning* ; Thinking ; Child Health ; Surveys and Questionnaires

PURPOSE: Hybrid therapy with catheter ablation of the cavo-tricuspid isthmus (CTI) and continuation of anti-arrhythmic drugs (AAD), or electrical cardioversion with AADs might be alternative treatments for patients with persistent atrial fibrillation (AF). The goal of study was to assess the long term success rate of hybrid therapy for persistent AF compared to antiarrhythmic medication therapy after electrical cardioversion and identify the independent risk factors associated with recurrence after hybrid therapy. MATERIALS AND METHODS: A total of 32 patients with persistent AF who developed atrial flutter after the administration of a class Ic or III anti-arrhythmic drug were enrolled. This group was compared with a group (33 patients) who underwent cardioversion and received direct current cardioversion with AADs. Baseline data were collected, and electrocardiogram and symptom driven Holter monitoring were performed every 2-4 months. RESULTS: There was no significant difference in the baseline characteristics between the groups. The 12 month atrial arrhythmia free survival was better in the hybrid group, 49.0% vs. 33.1%, p=0.048. However, during a mean 55.7+/-43.0 months of follow up, the improved survival rate regressed (p=0.25). A larger left atrium size was an independent risk factor for the recurrence of AF after adjusting for confounding factors. CONCLUSION: Despite favorable outcome during 12 month, the CTI block with AADs showed outcomes similar to AAD therapy after electrical cardioversion over a 12 month follow up period. Minimal substrate modification with AADs might be an alternative treatment for persistent AF with minimal atrial remodeling.
Adult ; Aged ; Anti-Arrhythmia Agents/*therapeutic use ; Atrial Fibrillation/*drug therapy/mortality/*surgery ; Catheter Ablation/*methods/mortality ; Combined Modality Therapy ; *Electric Countershock/mortality ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/mortality/prevention & control ; Retrospective Studies ; Risk Factors ; *Tricuspid Valve

Calvarial bone grafting in craniomaxillofacial trauma and facial reconstructive surgery is now widely recognized and accepted as a standard procedure. One of the commonly reported problems of calvarial bone graft is the contour defect caused by partial resorption of the graft. But, there are few reports that discuss the fate of the calvarial bone graft based on the quantitative data. In this article, the changes of grafted calvarial bone were evaluated using 3-dimensional computed tomography(CT). 9 patients were observed with the CT scans at 2mm thickness immediately after operation and at the time of last follow-up. The area of the bone defect was segmented on the 3-dimensional CT image and calculated by AnalyzeDirect 5.0 software. The immediate postoperative bone defect area of the recipient site and the donor site were 612.9mm2 and 441.5mm2, respectively, which became 1028.1mm2 and 268.8mm2, respectively at the last follow-up. In conclusion, the bone defect area was less increased on the donor site of calvarial bone graft than on the recipient site. And the CT scan is a valuable imaging method to assess and follow-up the clinical outcome of calvarial bone grafting.
Bone Transplantation ; Follow-Up Studies ; Humans ; Tissue Donors ; Tomography, X-Ray Computed ; Transplants*

A 56-yr-old man with aborted sudden cardiac death underwent implantable cardioverter defibrillator (ICD) implantation. While the ICD was being implanted, a left subclavian venogram failed to visualize the left subclavian vein, which was attributed to likely prolonged indwelling of the left subclavian sheath for venous access. Accordingly, the right subclavian vein was punctured and the ICD lead was diverted from the right side area to the active Can in the left pectoral area by tunneling over the sternum for high defibrillation threshold. The approach used in this case may be considered in patients who had difficult left subclavicular venous access and it may be prudent to save the left subclavian vein for ICD implantation in patients with fatal tachyarrhythmia.
Coronary Angiography ; Death, Sudden, Cardiac/prevention & control ; *Defibrillators, Implantable ; Electric Countershock ; Electrocardiography ; Heart Rate ; Humans ; Male ; Middle Aged ; Stents ; Subclavian Vein/*surgery ; Tachycardia, Ventricular/therapy

Non-reentrant focal tachycardias occur spontaneously, facilitated by catecholamine infusion, but they cannot be initiated or terminated with programmed stimulation. These tachycardias exhibit early activation before the QRS, however, do not typically show the mid-diastolic potential that is crucial for reentrant tachycardia maintenance. Electrophysiological studies are useful for distinguishing focal from macro-reentrant ventricular tachycardia. We report herein a case of patient without a history of structural heart disease who presented with a focal Purkinje ventricular tachycardia and heart failure. The focal Purkinje ventricular tachycardia was eliminated by radiofrequency catheter ablation. All of the patien's symptoms were improved after ablation.
Adult ; Cardiomyopathies/*surgery ; Catheter Ablation/*methods ; Humans ; Male ; Tachycardia, Ventricular/*surgery ; Ventricular Dysfunction/surgery

Biliary hamartomas are tumor-like malformations of the liver. Biliary hamartomas are a type of fibrocystic disorder originating from ductal plate malformation and are typically considered benign, but with the risk of malignant transformation. In this case report, we present a rare occurrence of intrahepatic cholangiocarcinoma (ICC) that developed from biliary hamartomas, along with a literature review. A 76-year-old man with a diagnosis of biliary hamartomas had a history of recurrent cholangitis for 12 years, necessitating cholecystectomy, ERCP, and repeated antibiotic treatments. During his last episode, imaging studies revealed a hypervascular infiltrative mass in the right posterior liver segment. A liver biopsy confirmed adenocarcinoma and subsequent surgical pathology revealed ICC originating from biliary hamartomas. Chronic inflammation in the bile duct associated with biliary hamartomas may serve as a potential trigger for malignant transformation, as observed in this case. Therefore, close surveillance is essential for patients with biliary hamartomas presenting with infectious complications.