We investigated the ventilatory changes in healthy patients without cardiopulmonary pathology during elective laparoscopic cholecystectomy in the head-up position. During surgery, intraabdominal pressure was maintained at 15 mmHg by a CO2 insufflator, and minute ventilation was controlled with a constant tidal volume and fixed respiratory rate. PETCO2 was monitored continuously and recorded every minute. Basic hemodynamic and ventilatory parameters were measured before anesthesia; after induction of anesthesia; at 5 min, 10 min and 30 min after peritoneal insufflation; and 5 min and 10 min after exsufflation. Arterial blood samples were obtained 3 times to calculate D(a-A)CO2, VD/VT, and Vco2. The latent period of PETCO2 change was 2.9 min, the ascending period was 12.6 min, and the descending period was 12.2 min. During the 71.5 min of pneumoperitoneum, V(I), VE, peak and plateau Paw increased, while Cdyn decreased significantly. Peritoneal insufflation or exsufflation also resulted in a significant change of D(a-A)CO2, D(a-A)O2, and Vco2. The anesthesiologist must be aware of both hemodynamic and ventilatory changes and must be ready to respond promptly and adequately.
Adolescence ; Adult ; Colectomy* ; Colon/surgery* ; Human ; Intraoperative Period ; Laparoscopy* ; Posture ; Respiration*

The purpose of this study was to describe the differences in three phenomenological research methods used to understand the experience of families of patients with cancer and so provide as guideline to novices first attempting qualitative research. The subjects were 3 family members - spouse, daughter, daughter-in-law -of cancer patients at S-hospital. Unstructured deep interviews were carried out and taped for further analyzed. Interviews were analyzed using three phenomenological methods ; Giorgi's, Colazzi's, and Van Kaam's. The results are as follows: The experience of family the analyzed using Giorgi's method showed different characteristics according to the family members' role. According to Colaizzi's method, they experienced burden, a willingness to care, role conflict, thanks to family and significant others, and ambivalence about treatment. Using Van Kaam's methodology, two categories were identified ; change of family function and burden. Themes in change of family function were positive attitude(9), role conflict(6), negative attitude(5), active attitude(2), and passive attitude(2) ; Themes in burden were emotional burden, physical burden, and economic burden. The result from using Giorgi's method were centered or individual characteristics and these results constituteds situational structured description and a general structured description. From Colaizzi's method the focus was on the common experience of all fo the subjects. In Van Kaam's method, subthemes (13), themes(8), and categories(2) were identified. So researchers should choose the qualitative method according to their research goals and methodological characteristics.
Humans ; Nuclear Family ; Qualitative Research ; Research Design* ; Spouses

Endometrial carcinoma has been the most common female pelvic malignancy in the U.S.A. Approximately one-fourth of patient treated for early endometrial cancer will develop reccure-nt disease. Kelly and Baker first descibed that the use of progestational agents for treatment of met- astatic endometrial cancer in 1961. Response of progesterone therapy in metastatic endometrial cancer is related to several factors. Higher response rates are observed in well differentiated tumors, longer disease free interval and tumors that positive for estrogen and progesterone re- ceptors. We experienced a case of complete response in recurrent endometrial cancer to metastasis to lung treated by tamoxifen and progesterone, we present this case with a brief review of lite- rature.
Endometrial Neoplasms* ; Estrogens ; Female ; Humans ; Lung* ; Neoplasm Metastasis* ; Progesterone* ; Progestins ; Tamoxifen*

BACKGROUND: At present, there are many instruments to diagnose anxiety and depression. However, most of the instruments have a number of questions. Therefore, we have many difficulties in applying them to the primary care. The purpose of this study was to measure the reliability and the validity of a Korean-translated Goldberg s short screening scale for anxiety and depression, which were developed for screening of anxiety and depression in primary care. METHODS: 178 asymtomatic subjects and 58 patients(anxiety 15, depression 43) aged from 18 to 64 years old were selected. The patients were diagnosed by psychiatrist according to DSM-IV criteria. This study was performed for 3 months, from May to August 1996. The reliability of this instrument was measured by internal consistency reliability. The validity of this instrument was measured by three methods. The first method was the comparison of the score between the patients and the control group. The second method was to measure the relationships of this instrument with the other instruments such as Self-rating Depression Scale and State-Trait Anxiety Inventory. The last method was to measure the relationship of this instrument with Comprehensive Global Assessment. In addition, we calculated the sensituvity and specificity at the cut off values. RESULTS: The Cronbach's a value was 0.736 for the anxiety and 0.749 for the depression. Goldberg anxiety scale was significantly associated with state in STAI(r=0.279, P<0.001), and trait in STAI(r=0.125, P=0.041). However, Goldberg depression scale was not sigficantly associated with SDS. Goldberg anxiety scale as well as Goldberg depression scale were significantly associated with CGA(r=0.433, P=0.001; r=0.695, P=0.001). The seore of Goldberg anxiety scale was significantly higher in the anxious patients than in the control group(P=0.047). The score of Goldberg depression scale was significantly higher in the depressive patients than in the control group(P<0.001). For anxiety scale of Goldberg scale, the sensitivity and the specificity was 60% and 68% at score 3. For depression scale of Goldberg scale, the sensitivity and the specificity was 80% and 68% at score 2. CONCLUSIONS: We concluded that the value of Cronbach's a in Goldberg scale was 0.736 for anxiety and 0.749 for depression. For the validity, the scores of Goldberg scale were higher in patient group than in asymptomatic group. However, the relationships of Goldberg scale with other screening instruments were variable. So further study for the validity of Goldberg scale is requested.
Anxiety* ; Depression* ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mass Screening* ; Middle Aged ; Primary Health Care ; Psychiatry ; Sensitivity and Specificity

BACKGROUND: To ensure patient safety and improvements in the quality of hospital care, rapid response teams (RRTs) have been implemented in many countries, including Korea. The goal of an RRT is early identification and response to clinical deterioration in patients. However, there are differences in RRT systems among hospitals and limited data are available. METHODS: In Seoul St. Mary's Hospital, the St. Mary's Advanced Life Support Team was implemented in June 2013. We retrospectively reviewed the RRT activation records of 287 cases from June 2013 to December 2016. RESULTS: The median response time and median modified early warning score were 8.6 minutes (interquartile range, 5.6 to 11.6 minutes) and 5.0 points (interquartile range, 4.0 to 7.0 points), respectively. Residents (35.8%) and nurses (59.1%) were the main activators of the RRT. Interestingly, postoperative patients account for a large percentage of the RRT activation cases (69.3%). The survival rate was 83.6% and survival was mainly associated with malignancy, Acute Physiology and Chronic Health Evaluation-II score, and the time from admission to RRT activation. RRT activation with screening showed a better outcome compared to activation via a phone call in terms of the intensive care unit admission rate and length of hospital stay after RRT activation. CONCLUSIONS: Malignancy was the most important factor related to survival. In addition, RRT activation with patient screening showed a better outcome compared to activation via a phone call. Further studies are needed to determine the effective screening criteria and improve the quality of the RRT system.
Epidemiology* ; Humans ; Intensive Care Units ; Korea ; Length of Stay ; Mass Screening ; Patient Safety ; Physiology ; Reaction Time ; Retrospective Studies ; Seoul ; Survival Rate

No abstract available.
Actinomycosis*

Fibrous dysplasia is a benign bone lesion characterized by the replacement of the normal substances of the interior of the bone by fibroosseous connective tissue histologically exhibiting varying degrees of osseous metaplasia. Craniofacial dysplasia represents approximately 2.5% of all bone tumors and 7.5% of benign bone tumors. Craniofacial dysplasia frequently affects the maxilla and frontal bone and induces local facial swelling and exophthalmos. The dysplasia has predilection for membranous bone such as femur or tibia, so its origin in the ethmoid is very rare. Recently, we experienced a case of fibrous dysplasia originating in the ethmoid bone extending to intracranial region. Our case demonstrated a huge bony lesion involving right ethmoid, frontal and sphenoid bone and extending to the left frontal area extensively forming a large dumbbell shaped cyst with thin calcified wall. There are no reported cases of fibrous dysplasia forming huge cyst in the intracranial region internationally. Hence, we report a case of fibrous dysplasia of ethmoid sinus forming the intracranial huge cyst.
Connective Tissue ; Ethmoid Bone* ; Ethmoid Sinus ; Exophthalmos ; Femur ; Frontal Bone ; Maxilla ; Metaplasia ; Sphenoid Bone ; Tibia

BACKGROUND: Patency of the infarct-related coronary artery may influence LV remodeling, provide a more stable electrophysiologic milieu and improves the outcome of patient with acute myocardioal infarction. The result from clinical trials have confirmed that early reperfusion in humans induced by a thrombolytic agent is associated with limitation of infarct size, preservation of ventricular function, and improved survival. The purpose of this study was evaluate the effect of thrombolytic therapy on the severity of the residual stenosis, antegrade flow of infarct-related coronary artery after acute myocardial infarction, and investigate left ventricular function and regianal wall motion abnormality depending on the thrombolytic therapy. METHODS: A retrosperctive study was performed in 166 patients with acute myocardial infarction with underwent coronary angiography within 8 days after acute attack from Oct. 1990 to Sep. 1994. Patients were grouped as thrombolysis group(n=64) who had undertaken urokinase infusion therapy within 6 hours of symptom onset and conservatively treated group(n=102) who had not received thrombolytic trerapy. At 8+/-7days, cardiac catheterization was performed. Status of the infarct related artery was assessed by resiudal % diameter stenosis, TIMI and collateral trading. Left ventricular function and wall motion were analyzed. RESULTS: 1) The was no statistical differenccs in age, sex and risk factors(diabetes, hypertension, smoking and hypercholesterolemia)between two groups. 2) The peak serum CK level was higher(2719+/-2333 vs 1951+/-2064 IU/L) and time to peak CK enzyme level was shorter(19+/-13 vs 32+/-24 hr) in thrombolysis group than conservatively treated group. 3) There was lower incidence of total occlusion(12.5% vs 30.4%), residual % diameter stenosis of infarct-related artery(67+/-34% vs 80+/-27%) and better antegrade flow(TIMI grade 0-1, 12.5% vs 32.4%) in thrombolysis group than conservatively treated group(p<0.05). 4) There were no statistical differences of ejection fraction(51+/-15 vs 51+/-14%). left ventricular end diastolic pressure(21+/-10 vs 21+/-16mmHg) and regional wall motion score(8.6+/-3.4 vs 9.1+/-3.1) between thrombolysis group and conservatively treated group(p>0.05). CONCLUSION: Thrombolytic therapy in acute myocardial infarction resulted in dquisition of early infarct-related arterial patency, effectiove antegrade flow and reduced incidence of totoal occlusion of infarct-related artery. Left ventricular ejection fraciton, regional wall motion score was not affected by thrombolytioc therapy in inhospital period.
Arteries ; Cardiac Catheterization ; Cardiac Catheters ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels* ; Humans ; Hypertension ; Incidence ; Infarction ; Myocardial Infarction* ; Reperfusion ; Smoke ; Smoking ; Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator ; Ventricular Function ; Ventricular Function, Left*

OBJECTIVES: Corticotropin releasing factor (CRF) plays a primary role in coordinating the neuroendocrine, autonomic, immune and behavioral responses to stress. CRF exerts its action through two major receptors, corticotropin-releasing factor 1 Receptor (CRF-R1) and corticotropin-releasing factor 2 receptor (CRF-R2). Using two types of chronic stress models, we investigated the changes of CRF-R1 mRNA and CRF-R2A mRNA expressions and CRF mRNA in the stress related brain circuit areas. METHODS: Male Sprague-Dawley rats were exposed to either immobilization stress or variable intermittent unpredictable stress for 10 days and then in situ hybridization histochemistry was used to quantify CRF expression in the brain. RESULTS: 1) CRF1 receptor mRNA expressions were decreased in bed nucleus stria terminalis (BNST) following stressors. 2) CRF2A receptor mRNA expressions were increased in lateral septum following stressors. 3) CRF mRNA expressions were increased in central nucleus of amygdala (CeA) and BNST. CONCLUSION: The increased CRF mRNA of CeA and BNST may be related with anxiety response in the repeated stress. Down-regulation of CRF-R1 mRNA expression in BNST may represent a compensatory adaptation to chronic stress and may be involved in the anxiety response, whereas up-regulation of CRF-R2A mRNA expression in lateral septum may represent an anxiety response or impaired learning but the functional meaning is uncertain.
Adrenocorticotropic Hormone* ; Amygdala ; Anxiety ; Brain ; Corticotropin-Releasing Hormone* ; Down-Regulation ; Humans ; Immobilization ; In Situ Hybridization ; Learning ; Male ; Rats, Sprague-Dawley ; Receptors, Corticotropin-Releasing Hormone ; RNA, Messenger ; Up-Regulation

BACKGROUND: The purpose of this study is to evalute the clinical findings, DeBakey classification, major associated complication, and mortality of aortic dissection. METHOD: A retrospective clinical study was done on 43 cases of aortic dissection who had been admitted to Wonju College of Medicine Hospital from January, 1988 to September, 1994. We classified to DeBakey type, and dissection was considered to be acute if elapsed time from clinical onsets to admission was less than 2 weeks. RESULTS: 1) Aortic dissection was seen a little more frequently in women than men with M : F ratio of approximately 1 : 1.3. The peak incidence was in the fifth, with the range being 30 to 70 years of age. 2) The frequent symptoms were pain in 67.4%, dyspnea in 9.3%, mental deterioration in 9.3%, syncope in 4.7%, and others in 9.3%. Anterior chest pain was most seen in type I, II of DeBakey classification. But, abdominal pain or back pain were mainly seen in type III dissection. 3) Hypertension was the most frequent physical finding in 72.1% and shock in 16.2%, pulse deficit in 23.6%, neurologic manifestation in 14%. 4) The diagnosing of aortic dissection was made by transthoracic echocardiography in 44.2%, transesophageal echocardiography in 23.3%, computed tomography in 65.1%, magnetic resonance imaging in 23.3%, and aortogram in 20.9%. 5) According to the DeBakey classification, type I was found in 23.3%, type II in 16.3%, and type III in 60.5%. 6) According to the age of dissection, acute dissection was found in 72.1%, chronic dissection in 27.9%. 7) Aortic regurgitation was complicated in 16.3%, pericardial effusion in 9.3%, hemothorax in 25.6%, and renal involvement in 14%. Aortic regurgitation, pericardial effusion, and hemothorax were mainly complicated in type I or type II aortic dissection, and renal vascular involvement was complicated in type I or type II dissection. 8) The hospital death rate was 27.9%. Mortality was high in acute dissaction, typeI or type II dissection and complicated dissection. CONCLUSIONS: The incidence of aortic dissection was more predominant in female patients. Most commom intial chief complaints was pain. Hypertension was combined in 72% of the patients. According to the DeBakey type, most common type was type III(60%). Complication of aortic dissection was aortic regurgitation(16%), pericardial effusion(9%), hemothorax(25%), renal arterial involvement(14%). In hospital mortality was 28% and more increased in patients with proximal dissection and combined complication.
Abdominal Pain ; Aortic Valve Insufficiency ; Back Pain ; Chest Pain ; Classification ; Dyspnea ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Gangwon-do ; Hemothorax ; Hospital Mortality ; Humans ; Hypertension ; Incidence ; Magnetic Resonance Imaging ; Male ; Mortality ; Neurologic Manifestations ; Pericardial Effusion ; Retrospective Studies ; Shock ; Syncope