BACKGROUND: Opioid analgesics are widely used to reduce postoperative pain and to enhance post-operative recovery. However, orthostatic intolerance (OI) induced by opioid containing intravenous patient controlled analgesia (IPCA) may hinder postoperative recovery. This study investigated factors that affect OI in patients receiving IPCA for postoperative pain control. METHODS: OI was instantly evaluated at the time of first ambulation in 175 patients taking opioid containing IPCA after open and laparoscopic subtotal gastrectomies. Patients were classified as having OI if they experienced dizziness, nausea/vomiting, blurred vision, headache, somnolence and syncope. Factors contributing to OI were assessed with logistic regression analysis. RESULTS: Out of 175 patients, 61 (52.6%) male and 44 (74.6%) female patients experienced OI at the time of first ambulation. The frequency of OI related symptoms were dizziness (97, 55.4%), nausea (46, 26.3%), headache (9, 5.1%), blurred vision (3, 1.7%) and vomiting (2, 1.1%). Significant risk factors for OI were gender (P=0.002) and total amount of opioids administered (P=0.033). CONCLUSIONS: The incidence of OI is significantly higher in male than in female patients and is influenced by the opioid dose.
Analgesia, Patient-Controlled ; Analgesics, Opioid ; Cyanoacrylates ; Dizziness ; Female ; Gastrectomy ; Headache ; Humans ; Incidence ; Logistic Models ; Male ; Nausea ; Orthostatic Intolerance ; Pain, Postoperative ; Risk Factors ; Syncope ; Vision, Ocular ; Vomiting ; Walking

PURPOSE: The purpose of this study was to investigate how nurses perceive the Career Ladder System(CLS). METHODS: This study was a descriptive survey using questionnaires. Questionnaires were developed by an expert group. Participants included 161 nurses working in the Children's Hospital. The data were analyzed using factor analysis, Cronbach's alpha, descriptive statistics, chi-square-test and ANCOVA. RESULTS: This study revealed that nurses who advanced in their career ladders have a significantly higher perception of participation in their professional activities and a general comprehension of the CLS more than the nurses who did not advance in their career ladders. However, nurses who advanced in their career ladders have a significantly lower perception of the expected outcome of the CLS more than nurses who did not. CONCLUSIONS: This result showed that nurses who had experienced in clinical advancement and recognition were highly motivated with their professional activities via the CLS as well as they considered it to allow professional growth.
Career Mobility ; Comprehension ; Surveys and Questionnaires

Recent studies(Rorke et al., 1968: Moir 1970: Baraka, 1970: Fox and Houle, 1971) have demonstrated that the maternal arterial oxygen tension during Cesarean section is an important determinant of fetal oxygenation and consequently of the clinical condition of the infant at birth for oxygen is transferred by simple diffusion across the placenta to the fetus. Fetal blood oxygen tension is affected by the arteiral oxygen tension and concentration of the mother, and also is affected by uterine blood flow(Fox and Houle, 1971). The enlarged uterus pushes the diaphragm upwards. This results in a change in position of the heart which is lifted upwards, shifted to the left and anteriorly, and a change in the thoracic cage, and heart rate is increased about 10~12 beats above normal. There is a significant increase in cardiac output which reaches a peak 30~50% above normal until term, and in respiratory rate, so that it follows that oxygen consumption increases but its direct cause is the metabolic need of the uterus, placenta and fetus(Atkinson et al., 1977). As well as increased oxygen consumption in parturients hypoxia may occur in situations of difficult intubation, laryngoscopy for intubation, extubation and during endotracheal suctioning. Because of the markedly decreased oxygen tension, these procedures are more dangerous than for non-parturients. Therefore sufficient oxygenation is recommanded(Archer and Marx, 1974). We selected at random 78 adult female patients who had received Cesarean section and other surgical procedures under general anesthesia with intubation at Severance Hospital from September to November, 1980. They were divided into 3 groups. Group 1 was ventilated with 100% oxygen for 5 minutes followed by 1 minute of apnea. Group 2 was ventilated with 50% oxygen for 5 minutes followed by 1 minute of apnea. Group 3 was ventilated with 50% oxygen for 5 minutes followed by 1 minute of apnea with endotracheal suction. We analysed the decrease in oxygen tension between parturients and onoparturients. The results were as follows: 1) During apnes, the decreases in arterial blood oxygen tension were significantly greater (p<0.05) in parturients than in non-parturients in the 100% oxygen group. 2) During apnea, the decreases in arterial blood oxygen tension were significantly greater(p<0.05) in parturients than in non-parturients in the 50% oxygen group. 3) During apnea, the decreases in oxygen tension were significantly greater(p<0.05) in paturients than in non-paturients in the 50% oxygen and endotracheal suction group. These results indicate the importance of preoxygenation prior to endotracheal intubation and endotracheal suction and also of prompt reoxygenation following endotracheal intubation, extubation and endotracheal suction.
Adult ; Anesthesia, General ; Anoxia ; Apnea* ; Cardiac Output ; Cesarean Section ; Diaphragm ; Diffusion ; Female ; Fetal Blood ; Fetus ; Heart ; Heart Rate ; Humans ; Infant ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Mothers ; Oxygen Consumption ; Oxygen* ; Parturition ; Placenta ; Pregnancy ; Respiratory Rate ; Suction ; Uterus

BACKGROUND: Early ambulation after anorectal surgery may be possible by relieving pain with intrathecal morphine and decreasing headache and backache with a much thinner and pencil-point needle. The difference in urinary peak flow rate in upright posture compared with recumbent position was reported to be highly significant, although acute urinary retention induced by intrathecal morphine may be decreased by early ambulation. METHODS: Eighty patients due for anorectal surgery were selected to receive spinal anesthesia. Subjects in group A (n=40) received 0.5% tetracaine 5 6 mg through a 25-gauge Quinke needle while group B (n=40) received 0.5% tetracaine 5 6 mg and intrathecal morphine 0.2 mg through a 27-gauge Whitacre needle. Postoperatively, group A received 24 hours bed rest and group B was recommended to walk as soon as possible. The duration of pain relief, onset time to ambulation, headache, backache, urinary retention and nausea were observed in both groups. RESULTS: The average onset time of early ambulation and duration of postoperative pain relief in group B was 3.6 +/- 1.0 and 15.1 +/- 3.5 hours respectively. The incidence of postspinal headache and backache was 2.5 and 5.0% in group B respectively and decreased significantly in comparison with group A (20.0 and 22.5%) respectively (P < 0.05). However, the incidence of postoperative nausea was 35.0% in group B and increased in comparison with group A (12.5%) (P < 0.05). Group B yielded a relatively lower urinary retention rate (40.0%) than group A (52.5%), but the difference did not reach statistical significance. CONCLUSIONS: Intrathecal morphine infused by a 27-gauge Whitacre needle provided postoperative pain relief with early ambulation, and decreased headache and backache, but we suggest that there is a need to select another drug or method instead of intrathecal morphine to decrease the incidence of urinary retention and nausea.
Anesthesia, Spinal ; Back Pain ; Bed Rest* ; Early Ambulation* ; Headache ; Humans ; Incidence ; Morphine* ; Nausea ; Needles* ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Posture ; Tetracaine ; Urinary Retention ; Walking

A study was made on the two cases of Klinefelter's Syndrome with review of literature. Two cases revealed findings of characteristics of Kiinefelter's Syndrome such as small testes, atrophy of seminiferous tubules, azoospermia, increased urinary gonadotropin, decreased urinary 17 Ketosteroid, positive Sex Chromatin, gynecomstia and impotence.
Atrophy ; Azoospermia ; Erectile Dysfunction ; Gonadotropins ; Klinefelter Syndrome* ; Male ; Seminiferous Tubules ; Sex Chromatin ; Testis

No abstract available.
Brain* ; Tomography, Emission-Computed, Single-Photon*

Eighty-four patients with unresectable primary hepatocellular carcinoma due either to locally advanced lesion or to association with liver cirrhosis were treated with combined radiotherapy and hyperthermia from April 1988 to January 1991. Purpose of this study was to assess thermometry, response rate, toxicity, and survival in those patients. External radiotherapy was given with a total of 30.6 Gy/3.5 wks. Hyperthermia was given twice a week with a total of 6 treatment sessions using an 8 MHz radiofrequency capacitive type heating machine. Each hyperthermia session was started within 30 min following radiotherapy and continued for 30-60 min. Thermal data were analysed with maximum, minimum, and average temperatures of the tumors. Thermal mapping was also done. In thermometry results, maximum, minimum, and average temperatures of the tumors were 41.9 +/- 1.3 degrees C, 39.9 +/- 1.0 degrees C, and 40.8 +/- 0.9 degrees C, respectively. The fraction over 40 degrees C was 73 +/- 32% with a wide variation from 15% to 100%. Among 67 assessable patients, 27 patients showed tumor regression of more than 50% of the original tumor volume (40.3% response rate). Symptomatic improvement was observed in 78.6% of the patients. Acute toxicities during the treatment were mostly acceptable local pain (51.2%) and local fat necrosis (13.1%). The actuarial 1-year, 2-year, and 3-year survival rates were 44.8%, 19.7%, and 15.6%, respectively. Median survival was 6 months. In view of acceptable toxicities and the current rate of survival, further evaluation of combined treatment of radiotherapy and hyperthermia for unresectable hepatocellular carcinoma is warranted.
Carcinoma, Hepatocellular/radiotherapy/*therapy ; Combined Modality Therapy ; Female ; Human ; *Hyperthermia, Induced ; Liver Neoplasms/radiotherapy/*therapy ; Male ; Middle Age ; Remission Induction

No abstract available.
Tetracycline* ; Thyroid Gland* ; Thyroid Nodule*

BACKGROUND: Blood supply in Korea has been unstable in more than a year because transfusion-related infection was repeated in patients receiving blood that the Korean Red Cross Blood Center (KRCBC) had supplied. The purpose of this study is to contribute to stable and efficient blood supply in our country by analysis of present status of hospital blood banks as blood donation center and their satisfaction levels with the KRCBC. METHODS: From July to August 2004, we performed questionnaire survey in 129 hospital blood banks that the KRCBC issued donor card in 2003. Among them, 73 hospitals replied and we analyzed them. RESULTS: Fifty-one (69.8%) among 73 hospital blood banks collected less than 100 cases of blood donation in 2003 and 16 of them collected no blood component. Satisfaction level with KRCBC was only 1.8 in hospitals less than 300 beds. Improvement in the delivery of blood components and blood testing of donated blood were in highest need among all areas of services supplied by KRCBC. Hospitals more than 1,000 beds answered that they would not transfer the collection service to KRCBC no matter how NAT be performed in all donated blood because of the directed and autologous donation of their hospitals. CONCLUSION: Satisfaction level of Hospital blood banks in Korea with blood services of KRCBC was rated below average, especially in hospitals less than 300 beds. It is important that the government should be the subject of national blood services and suggest appropriate schemes such as national audit program through close cooperation with the KRCBC and hospitals.
Blood Banks* ; Blood Donors* ; Hematologic Tests ; Humans ; Korea ; Red Cross* ; Tissue and Organ Procurement ; Surveys and Questionnaires

No abstract available.
Angioplasty* ; Constriction, Pathologic*