PURPOSE: This study was conducted to investigate patients' characteristics and actual conditions of home-based services offered by a free-standing hospice center. METHODS: A retrospective review was performed with the medical records of 75 patients who received home-based hospice care from a free-standing hospice center from January 2014 through December 2014. RESULTS: Most patients (54.7%) were enrolled via self-directed referral. The reason for the service termination was death at home 25.3%, admission to a hospice ward 50.7%, hospitalization 22.6% and patients' refusal 2.7%. Seventy three patients had cancer, and two patients had ALS. Among all, 58.7% were in a dying phase, and 34.7% were almost completely bedfast at the time of their enrollment in this study. When they enrolled, the patients' physical symptoms were characterized as pain (89.4%), sleep disturbance (71.2%), urinary difficulties (35.8%) and defecation difficulties (47.8%). Among all, 77.4% terminated the home visit service within one month. The mean frequency of the home visits was 3.25 (±3.98), and less than five in 82.7% of patients. The mean frequency of the phone service was 3.40 (±3.12). The frequency of doctor's home visits was 1.21±0.79 on average, and the figure increased when patients' conditions turned unstable. CONCLUSION: It is necessary to develop a home-based hospice care model with consideration of patients' characteristics and the actual service conditions delivered by free-standing hospice facilities.
Defecation ; Home Care Services ; Hospice Care* ; Hospices* ; Hospitalization ; House Calls ; Humans ; Medical Records ; Referral and Consultation ; Retrospective Studies

PURPOSE: In the era of shock wave lithotripsy (SWL) and ureteroscopy, the majority of ureter stones are successfully managed with these less invasive treatment modalities. However, open ureterolithotomy still has a role in special situations. The efficacy of a laparoscopic retroperitoneal ureterolithotomy for large impacted ureter stones indicated for open ureterolithotomy is reported. MATERIALS AND MTHODS: Between February 1998 and December 1999, laparoscopic retroperitoneal ureterolithotomy for proximal ureter stones was performed in 5 patients who required an open ureterolithotomy. The mean size of the stones was 15mm, all of which were tightly impacted in the ureteral lumen and were associated with marked hydronephrosis. RESULTS: All but the initial operation was performed successfully via the retroperitoneal approach. Open conversion was needed in the first patient because of inexperience and the lack of anatomic perception. The mean operation time and estimated blood loss was 122 minutes and < or =50ml, respectively. A transfusion was not needed in any of the patients. Postoperative pain was well controlled with 175mg of Ketoprofen. The mean postoperative length of hospital stay was 6.3 days. There were no significant intraoperative or postoperative complications. CONCLUSIONS: A laparoscopic retroperitoneal ureterolithotomy can be considered as an alternative to conventional ureterolithotomy when open surgery is indicated.
Humans ; Hydronephrosis ; Ketoprofen ; Laparoscopy ; Length of Stay ; Lithotripsy ; Pain, Postoperative ; Postoperative Complications ; Shock ; Ureter ; Ureteroscopy

PURPOSE: In the era of shock wave lithotripsy (SWL) and ureteroscopy, the majority of ureter stones are successfully managed with these less invasive treatment modalities. However, open ureterolithotomy still has a role in special situations. The efficacy of a laparoscopic retroperitoneal ureterolithotomy for large impacted ureter stones indicated for open ureterolithotomy is reported. MATERIALS AND MTHODS: Between February 1998 and December 1999, laparoscopic retroperitoneal ureterolithotomy for proximal ureter stones was performed in 5 patients who required an open ureterolithotomy. The mean size of the stones was 15mm, all of which were tightly impacted in the ureteral lumen and were associated with marked hydronephrosis. RESULTS: All but the initial operation was performed successfully via the retroperitoneal approach. Open conversion was needed in the first patient because of inexperience and the lack of anatomic perception. The mean operation time and estimated blood loss was 122 minutes and < or =50ml, respectively. A transfusion was not needed in any of the patients. Postoperative pain was well controlled with 175mg of Ketoprofen. The mean postoperative length of hospital stay was 6.3 days. There were no significant intraoperative or postoperative complications. CONCLUSIONS: A laparoscopic retroperitoneal ureterolithotomy can be considered as an alternative to conventional ureterolithotomy when open surgery is indicated.
Humans ; Hydronephrosis ; Ketoprofen ; Laparoscopy ; Length of Stay ; Lithotripsy ; Pain, Postoperative ; Postoperative Complications ; Shock ; Ureter ; Ureteroscopy

STATEMENT OF PROBLEM: Fracture of composite resin core will be occurred by progress of crack. Bonding interface of different materials has large possibility of starting point of crack line. Therefore, the bond strength of glass fiber post to composite resin core is important for prevention of fracture. Purpose: This in vitrostudy tried to find out how to get the higher strength of glass fiber post to composite resin core through surveying the maximum load that fractures the post and core complex. MATERIALS AND METHODS: 40 specimens made with glass fiber Posts(Style post(R), Metalor, Swiss) and composite resin core(Z-100(R), 3M, USA) were prepared and loaded to failure with push-out type shear-bond strength test in a universal test machine. The maximum fracture load and fracture mode were investigated in the specimens that were restored with four different surface treatments. With the data, ANOVA test was used to validate the significance between the test groups, and Bonferroni method was used to check if there is any significant statistical difference between each test group. Every analysis was approved with 95% reliance. RESULTS: On measuring the maximum fracture load of specimens, both the treatments of sandblasted and acid-etched one statistically showed the strength increase rather than the control group(p<0.005). The scanning electric microscope revealed that sand blasting made more micro-retention form not only on the resin matrix but on the glass fiber, and acid-etching contributed to increase in surface retention form, eliminated the inorganic particles in resin matrix. Specimen fracture modes investigation represented that sand blasted groups showed lower bonding failure than no-sand blasted groups. CONCLUSION: Referring to the values of maximum fracture load of specimens, the bonding strength was increased by sand blasting and acid-etching.
Glass* ; Silicon Dioxide

BACKGROUND: International consensus guidelines have recently been developed to improve the assessment and management of asthma. One of the major recommendations of these guidelines is that asthma severity should be assessed through the recognition of key symptoms, such as nocturnal waking, medication requirements, and objective measurements of lung function. Differential classification of asthma severity would lead to major differences in both long term pharmacological management and the treatment of severe exacerbation. METHODS: This study examined the relationship between the symptom score and measurements of FEV1 and PEF when expressed as a percentage of predicted values in asthmatics(n=107). RESULTS: The correlation of FEV1% with PEFR% was highly significant(r=0.83, p<0.01). However, there was agreement in terms of the classification of asthma severity in 76.6% of the paired measurements of FEV1% and PEFR%. Agreement in the classification of asthma severity was also found in 57.1% of the paired analysis of FEV1% and symptom score. 39% of the patients classified as having moderate asthma on the basis of FEV1% recording would be considered to have severe asthma if symptom score alone were used. Low baseline FEV1 and high bronchial responsiveness were associated with a low degree of perception of airway obstruction. CONCLUSION: The relationships between the symptom score, PEFR and FEV1 were generally poor. When assessing asthma severity, age, duration, PC20, and baseline FEV should be considered.
Airway Obstruction ; Asthma* ; Classification ; Consensus ; Humans ; Lung ; Peak Expiratory Flow Rate

Cerebral malalria is a life-threatening complication of Plasmodium falciparum infection. RBC exchange transfusion (RCE) can reduce the burden of parasitemia in this situation. We have experienced two cases of cerebral malaria treated with automated RBC exchange as an adjunct to standard chemotherapy. Case 1: A 42-year-old male was referred to the emergency room with a history of 3 days of fever after having returned from Congo. Peripheral blood smear showed the P. falciparum parasitemia of 70-80%. Quinidine and doxycycline were administered but, mental state started to deteriorate. He underwent RCE on hospital day 2 to reduce the parasitemia to 10% after 8 hours. No parasite could be found on day 3 after the RCE. Case 2: A 62-year-old male was referred to the emergency room with a history of 3 days of fever after having returned from Cameroon. P. falciparum parasitemia was 10% on peripheral blood smear. Quinidine and doxycycline were immediately started but headache developed abruptly and he underwent RCE on hospital day 3. After 8 hours following the completion of RCE, parasitemia decreased to less than 1%. Automated RBC exchange transfusion can rapidly reduce the burden of parasitemia and achieve improvement of neurologic symptom and sign in patients with cerebral malaria.
Adult ; Cameroon ; Congo ; Doxycycline ; Drug Therapy ; Emergency Service, Hospital ; Fever ; Headache ; Humans ; Malaria, Cerebral* ; Male ; Middle Aged ; Neurologic Manifestations ; Parasitemia ; Parasites ; Plasmodium falciparum ; Quinidine

PURPOSE: This study evaluated the feasibility and efficacy of a percutaneous injection of a mixture of autogenous bone marrow and crushed cancellous bone allografts for the treatment of simple bone cysts. MATERIALS AND METHODS: Fifteen patients with a simple bone cyst were enrolled in this study. The mean age was 13.5 years (range, 4-32 years), and the mean follow-up period was 13.2 months (range, 8-19 months). The radiographic signs of the resolution of the cyst were categorized as healed, healed with a defect, persistent and recurrent. The groups of healed and healed with a defect were designated the positive response groups. RESULTS: Fourteen patients responded to the treatment. Nine patients showed complete healing that was first seen radiographically at 3 months (range, 1-6 months). Five patients showed healing with a defect, but no patient required a second injection because the cysts were small and did not cause functional pain. There was no correlation between clinical responses and age, gender, location, cyst index and previous treatment modalities. One patient had a pathological fracture, which was treated successfully by open bone grafting with flexible intramedullary nailing. CONCLUSION: A percutaneous injection of a mixture of autogenous bone marrow and a crushed cancellous bone allograft may be an effective treatment for simple bone cysts.
Allografts* ; Bone Cysts* ; Bone Marrow* ; Bone Transplantation ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Fractures, Spontaneous ; Humans

A 43-year-old woman with left facial pain caused by occipital neuralgia was scheduled for C2 ganglionotomy and adhesiolysis of left C2 root. General anesthesia, surgical procedure, and emergence have done uneventfully. However, she developed seizure after 5 minutes postoperatively in post-anesthesia recovery unit. She showed loss of consciousness and generalized muscular rigidity after shouting “I want to die”. Neurologic examination and neuroimaging revealed no neuronal damage. Her generalized muscular rigidity improved by her daughter's visit and worsened by mention about her husband, and disappeared after 40 minutes spontaneously.
Adult ; Anesthesia, General ; Facial Pain ; Female ; Humans ; Muscle Rigidity ; Neuralgia ; Neuroimaging ; Neurologic Examination ; Neurons ; Seizures* ; Spouses ; Unconsciousness

PURPOSE: This study aimed to determine the exact characteristics of bacterial colonization after a ureteral stent indwelling. MATERIALS AND MTHODS: The natural history of bacterial colonization on the stent itself and urine samples after different periods of stent indwelling was examined. A total of 57 double-J stents from 52 patients (21 male; 31 female) with mean age of 52 (range 20-79) years were examined. In all patients, short-term (for 2-3 days) antimicrobial therapy was done at the time of stenting. Regular urinalysis and urine culture were performed until the stent was removed. The stents were removed under aseptic conditions and the proximal and distal tip segments were obtained. Three culture specimens were acquired from each stent segments (inner surface washing suspension, outer surface washing suspension and the stent tip itself). RESULTS: Bacterial colonies were found in 44% (25/57). Multiple pathogens were identified, and Enterococcus species (6/25) was the most common pathogen followed by E. coli (5/25). The bacteria did not colonize within the first 2 weeks of indwelling. However, the colonization rate increased, as the duration of the indwelling was further increased. Colonization in the stent was followed by the colonization in the urine. CONCLUSIONS: Bacterial colonization does not occur during the initial 2 weeks after stent indwelling. This suggests that antibiotics for short-term indwelling of ureteral stents are not necessary.
Anti-Bacterial Agents ; Bacteria ; Bacterial Adhesion ; Colon* ; Enterococcus ; Humans ; Male ; Natural History ; Stents* ; Ureter* ; Urinalysis ; Urinary Tract Infections* ; Urinary Tract*

PURPOSE: This study aimed to determine the exact characteristics of bacterial colonization after a ureteral stent indwelling. MATERIALS AND MTHODS: The natural history of bacterial colonization on the stent itself and urine samples after different periods of stent indwelling was examined. A total of 57 double-J stents from 52 patients (21 male; 31 female) with mean age of 52 (range 20-79) years were examined. In all patients, short-term (for 2-3 days) antimicrobial therapy was done at the time of stenting. Regular urinalysis and urine culture were performed until the stent was removed. The stents were removed under aseptic conditions and the proximal and distal tip segments were obtained. Three culture specimens were acquired from each stent segments (inner surface washing suspension, outer surface washing suspension and the stent tip itself). RESULTS: Bacterial colonies were found in 44% (25/57). Multiple pathogens were identified, and Enterococcus species (6/25) was the most common pathogen followed by E. coli (5/25). The bacteria did not colonize within the first 2 weeks of indwelling. However, the colonization rate increased, as the duration of the indwelling was further increased. Colonization in the stent was followed by the colonization in the urine. CONCLUSIONS: Bacterial colonization does not occur during the initial 2 weeks after stent indwelling. This suggests that antibiotics for short-term indwelling of ureteral stents are not necessary.
Anti-Bacterial Agents ; Bacteria ; Bacterial Adhesion ; Colon* ; Enterococcus ; Humans ; Male ; Natural History ; Stents* ; Ureter* ; Urinalysis ; Urinary Tract Infections* ; Urinary Tract*