Postprandial hypotension is an important minor clinical problem. It is a common disorder that causes unexplained dizziness, falls, lightheadedness, syncope, angina pectoris, and even transient ischemic attacks of the brain. It is often defined as a decrease in systolic blood pressure by more than 20 mmHg within 2 hours after a meal. The mechanism of postprandial hypotension is splanchnic blood pooling via the loading of glucose in the intestine and decompensation of the autonomic nervous system. The best tool for detecting a fall in systolic blood pressure is 24-hour ambulatory blood pressure monitoring. Acarbose, an alpha-glucosidase inhibitor, is very useful for preventing postprandial hypotension. We experienced a case of postprandial hypotension that presented with postprandial dizziness. The patient was treated successfully with acarbose before each meal.
Acarbose ; alpha-Glucosidases ; Angina Pectoris ; Autonomic Nervous System ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Brain ; Dizziness ; Glucose ; Humans ; Hypotension ; Intestines ; Ischemic Attack, Transient ; Meals ; Syncope

Real-time ultrasound-guided fine-needle aspiration biopsy in 137 solid breast masses was performed. Sonographic findings were categorized into three group and aspirates were categorized into three cytologic groups. The cytologic result was reported benign masses (cytologic group 1) in 71 cases (52%), malignant masses (cytologic group 2 and 3) in 44 cases (32%) and insufficient specimens in 22 cases (16%). Insufficient specimens were treated as benign masses. Excisional biopsy in 44 malignant masses and 3 benigh masses according to cytologic results, clinical findings and follow up study was performed. The result was reported 41 malignant masses and 6 benign masses. Based on cytologic criteria, sensitivity for detection of malignancy was 93% and specificity was 94%. In conclusion, the high specificity provided by ultrasound-guided fine-needle aspiration biopsy could markedly reduce unnecessary surgical excisions for benign masses and it should be routinely performed, since it can give physical and emotional benefits to patients and lead to earlier and cost effective diagnosis of breast cancer.
Biopsy ; Biopsy, Fine-Needle* ; Breast Neoplasms ; Breast* ; Diagnosis ; Follow-Up Studies ; Humans ; Sensitivity and Specificity ; Ultrasonography

Desmoid tumor is rare neoplasm originated from fibrous sheath or musculoaponeurotic structure. It is classified as benign tumor histologically, but clinically, it has malignant characteristics due to its infiltrative growth to adjacent organ and frequent local recurrence. Especially, mesenteric desmoid tumor shows poor prognosis because of its symptoms of pain, intestinal obstruction, ureter obstruction and fistula formation and high frequency of recurrence. We experienced a case of mesenteric desmoid tumor in a 64-year-old woman with a painless abdominal mass. Laparoscopic exploration was performed and 10 cm sized mesenteric mass was identified, which resected widely and the diagnosis was confirmed with desmoid tumor by pathologic report. We reviewed the feature of the mesenteric desmoid tumor, that is, pathophysiology, clinical presentations, diagnosis, treatment and prognosis.
Female ; Fibromatosis, Aggressive ; Fistula ; Humans ; Intestinal Obstruction ; Laparoscopy ; Mesentery ; Prognosis ; Recurrence ; Ureter

A 63-year-old woman was referred to a breast surgeon with a breast mass discovered incidentally during follow-up study after colon cancer surgery. Invasive adenocarcinoma was revealed on core needle biopsy. Wide excision of the breast including the tumor was performed. On standard histological examination the tumor showed features of moderately differentiated adenocarcinoma. The immunohistochemistry study revealed positive results for cytokeratin (CK)20 and CDX2, but negative for CK7. These are typical characteristics for colon cancer. Considering her history of subtotal colectomy for sigmoid colon cancer, it is presumable that the mass in the breast was of colonic origin, and it was an extremely rare case of metastasis to the breast from primary colorectal neoplasm. Although the instance is rare, clinicians should keep the possibility of breast metastasis from colorectal cancer in mind for early and correct diagnosis.
Adenocarcinoma ; Biopsy, Large-Core Needle ; Breast ; Colectomy ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratins ; Middle Aged ; Neoplasm Metastasis ; Sigmoid Neoplasms

PURPOSE: The purpose of this study was to describe technological development, caring attributes and professional self-concept as perceived by nurses in YanBian. METHOD: Data were collected using an instrument containing 137 Likert items was administered to 477 RN's working in general hospitals in YanBian. The instrument contained sections which examined technological influences questionnaire(TIQ), caring attributes questionnaire(CAQ), and professional self-concept nursing inventory(PSCNI). RESULT: Descriptive and inferential statistics revealed by marital status and position. Married, working special ward nurses reported a higher TIQ score than that of unmarried and working general ward and OPD. PSCNI and CAQ score of head or supervisor nurses were higher than that of staff nurses. Subjects revealed very low score of CAQ, while PSCNI score was higher than that of other Asian countries such as Korea, Beijing China, HongKong China and Japan as proved in former study. CONCLUSION: Useful information for educators and nurse administrators is provided from this results. Further study needs to be done to discuss in the light of cultural and environmental differences between YanBian(Korean-Chinese) and Korean nurses.

Methemoglobinemia is an uncommon but potentially fatal disorder. Most cases have no adverse clinical consequence and require no treatment, but methemoglobinemia is often overlooked as a cause of low oxygen saturation, and often mistaken for the more common causes of hypoxia by anesthesiologists despite simple bedside tests that indicate the presence of this treatable abnormality. We present a 68-year-old female patient who underwent gastrectomy for advanced gastric cancer with bleeding. In the preoperative period, the patient showed cyanosis and oxygen saturation was 85% by pulse oximeter, but oxygen saturation by arterial blood gas analysis was 100%. After tracheal intubation, the methemoglobin level was 18.3%. Ascorbic acid and methylene blue were administered. During preanesthetic evaluation, the patient had not informed the anesthesiologist that she had been taking dapsone.
Aged ; Anesthesia, General ; Anoxia ; Ascorbic Acid ; Blood Gas Analysis ; Cyanosis ; Dapsone ; Female ; Gastrectomy ; Hemorrhage ; Humans ; Intubation ; Methemoglobin ; Methemoglobinemia ; Methylene Blue ; Oximetry ; Oxygen ; Preoperative Period ; Stomach Neoplasms

PURPOSE: To investigate the result of total knee arthroplasty (TKA) using an intra-articular correction in patients with extra-articular deformity of the femur. MATERIALS AND METHODS: We performed 23 TKAs in 23 patients with extra-articular deformity of the femur. The mean age was 58.0 years and the follow-up period averaged 54.7 months. The American Knee Society's knee and function score were evaluated, and the mechanical axis (MA) was measured. Sixteen knees with a deformity in the distal third of the femur were assigned to group I and 7 knees with a deformity in the proximal or middle third were assigned to group II. Between groups differences in results were analyzed. RESULTS: The average knee score was 47.8 preoperatively and 91.6 at the last follow-up. The average function score was 46.9 preoperatively and 89.1 at the last follow-up. The MA averaged varus was 7.7degrees preoperatively and 1.0degrees postoperatively. The average knee score at the last follow-up was 90.1 in group I and 95.0 in group II. The average function score at the last follow-up was 87.8 in group I and 92.1 in group II. The MA averaged varus was 2.0degrees in group I and 1.3degrees in group II (p=0.042). CONCLUSION: TKA in conjunction with intra-articular correction produced satisfactory results for patients with an extra-articular deformity of femur. The possibility of incomplete correction of limb alignment should be carefully considered, especially in cases with a severe deformity at the distal third of the femur.
Arthroplasty ; Axis, Cervical Vertebra ; Congenital Abnormalities ; Extremities ; Femur ; Follow-Up Studies ; Humans ; Knee

PURPOSE: To analyze the pre- and postoperative posterior tibial slope angle (PSA) of performing cruciate-retaining total knee arthroplasty (TKA) and to identify the ideal value of the PSA in relation to the clinical results. MATERIALS AND METHODS: From June 1999 to May 2005, 202 TKA with a NexGen(R) cruciate-retaining knee were performed in 160 patients. The mean follow-up period was 39.8 months. The pre- and postoperative PSA referenced by the proximal tibial medullary canal (PSA-A) and the proximal tibial anterior cortex (PSA-B) were measured by two independent observers. The knee and function scoring system of the American Knee Society and the range of motion of the knee at the last follow-up were evaluated as the clinical results. RESULTS: The mean PSA-A was 11.4+/-4.8degrees preoperatively and 6.0+/-2.8degrees postoperatively, and the mean PSA-B was 13.6+/-4.9degrees preoperatively and 8.1+/-2.9degrees postoperatively. The difference between the pre- and postoperative PSA increased as the preoperative PSA-A changed from 6.0degrees and the PSA-B changed from 8.1degrees; these findings showed statistical significance based on a simple linear regression (PSA-A: r= 0.837, p=0.000; PSA-B: r=0.834, p=0.000). The knee and function score of American Knee Society improved respectively from 62.9 and 55.8, preoperatively, to 97.4 and 89.7 respectively, at the last follow-up. The range of motion of the knee joint was 128.0degrees preoperatively and 129.7degrees at the last follow-up. CONCLUSION: In cruciate retaining total knee arthroplasty, PSA-A is mostly distributed within 3.2-8.8degrees, and a reasonable range of PSA-A is 6.0+/-2.8degrees.
Arthroplasty ; Follow-Up Studies ; Humans ; Knee ; Knee Joint ; Linear Models ; Range of Motion, Articular

BACKGROUND: The thoracic transforaminal epidural block (TTFEB) is usually performed to treat herpes zoster or postherpetic neuralgia (PHN). Especially, multiple segmental involvements and approximate contrast medium spread range, according to volume, help to choose the proper drug volume in the transforaminal epidural block. This study investigated the contrast medium spread patterns of 1-ml to 3-ml TTFEBs. METHODS: A total of 26 patients with herpes zoster or PHN were enrolled in this study. All participants received 1 ml, 2 ml, or 3 ml of contrast medium. Results were divided into Groups A, B and C based on the volume (1, 2, or 3 ml), with n = 26 for each group. After the injection of contrast medium, the spread levels were estimated in both the lateral and anteroposterior (AP) images using fluoroscopy. RESULTS: The cephalad spread of contrast medium in the lateral image as expressed by the median (interquartile range) was 2.00 levels (1.00–2.00) for Group A, 2.50 (2.00–3.00) for Group B, and 3.00 (2.00-4.00) for Group C. The caudal spread level of contrast medium was 1.00 (1.00-2.00) for Group A, 2.00 (2.00–3.00) for Group B, and 2.00 (2.00–3.00) for Group C. There was ventral and dorsal spread of the 3-ml contrast medium injection in 88% (23/26) of cases in the lateral image. CONCLUSIONS: Injection of 3 ml of contrast medium through the foramina spread 6 levels in a cephalocaudal direction. Spread patterns revealed a cephalad preference. TTFEB resulted in dorsal and ventral spread in a high percentage of cases. This procedure may be useful for transferring drugs to the dorsal and ventral roots.
Contrast Media ; Fluoroscopy ; Herpes Zoster ; Humans ; Injections, Epidural ; Nerve Block ; Neuralgia, Postherpetic ; Spinal Nerve Roots ; Spine

OBJECTIVE: We investigated the opinions of experts to identify problems and prepare an improvement plan when applying the Korean Triage and Acuity Scale (KTAS) to pediatric patients in the emergency department. METHODS: The experts comprised 15 researchers at a pediatric emergency center designated by the Ministry of Health and Welfare and research team members of the Korean Society of Pediatric Emergency Medicine. The first survey was an open-ended question about the problems, application results, and remedies of applying KTAS to children through e-mail. The problems were categorized by topic, and degree of agreement was presented using a 9-point Likert scale. RESULTS: In the first survey, 67% of experts participated and 18 problems were identified. In the second survey, 73% of experts participated and eight problems were identified in four categories, validity, reliability, feasibility and other opinions. All experts pointed out that resources were not considered during pediatric triage in the KTAS. Ninety-one percent of experts said that peak expiratory flow rate measurement and Glasgow Coma Scale evaluation were unlikely to be feasible. Moreover, 91% experts were concerned that the triage level could be distorted if KTAS was interlocked with medical costs. Eighty-two percent of the respondents pointed to the high triage result of febrile children and the difference in pain score between the evaluators, etc. CONCLUSION: Based on the problems pointed out by experts and the reality of Korea's emergency departments, it is necessary to consider revision of KTAS for children.
Child ; Delphi Technique ; Electronic Mail ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Glasgow Coma Scale ; Humans ; Peak Expiratory Flow Rate ; Surveys and Questionnaires ; Triage