This study was undertaken to investigate the casual perceptions and health seeking behaviors of Rheumatoid arthritis patients, define and understand the typology, and find the relationship between causal perceptions and health seeking behavioral types. There were six types(Physical Fatigue, Dispensation of Nature, Causality to Environment, Conscience of Guilty, Rationally perceiving, Psychological Stress) of subjective opinion about Causal Perceptions of Rheumatoid Arthritis Patients. And there were four types(Oriental medical Treatment, Information Seeking Dietary Control, Western Medical Treatment) of subjective opinion about Health Seeking Behaviors. In the relationship between types of the causal perceptions and health seeking behaviors, oriental medical treatment and information seeking type were common health seeking behaviors of all six causal perception types, Only difference for internal causal perception types was related to hospital instructions and external causal perception types were related to dietary control. The result of this study can help health care provides, especially nurses to understand the types of causal perceptions and health seeking behaviors of Rheumatoid arthritis patients to gain treatment educational nursing intervention to aid health care.
Arthritis, Rheumatoid* ; Conscience ; Delivery of Health Care ; Fatigue ; Humans ; Nursing

PURPOSE: The aim of this study was to evaluate the long term therapeutic results and complications of an anterior vaginal wall sling (AVWS) for female patients with stress urinary incontinence (SUI) followed up for over 3 years. MATERIALS AND METHODS: We analyzed 23 of 43 patients who could have been followed up for more than 3 years following an AVWS operation. The mean follow-up period was 40.2+/-5.3 months. The cystography and urodynamic study, including preoperative valsalva leak point pressure and subjective SEAPI scores, were examined in the patients. Postoperative analyses, including subjective SEAPI scores, success rates, satisfaction and complications were performed 3 years following the operations. RESULTS: The total preoperative subjective SEAPI score of 6.1+/-3.4 decreased postoperatively to 1.4+/-1.5 (p<0.001). Twenty one patients (91.3%) answered as "completely resolved" and one patient (4.3%) as "improved". Of the 12 patients accompanied by urgency preoperatively, 8 were completely improved directly following the operation, but the remaining 4 suffered longstanding urgency. De novo urgency occurred in 3 patients, but they all improved within 3 months with conservative management. Five patients (21.7%) suffered from postoperative inguinal pain, which improved in 4 after 3 months, an in about 9 months in the other. Subjective satisfaction exceeding 3 years following the operation was "very satisfactory" in 22 patients (95.6%). CONCLUSIONS: After more than 3 years, the 3 year follow-ups after AVWS operations in female patients with SUI showed a high success rate, high patient subjective satisfactions and reasonable complications. We think that an AVWS operation is an effective therapeutic procedure for female patients with SUI.
Female* ; Follow-Up Studies* ; Humans ; Urethra ; Urinary Incontinence* ; Urodynamics ; Vagina

PURPOSE: Most patients who finally diagnosed as the cecal and ascending colonic diverticulitis would complain pain on right low quadrant of abdomen. So many of them unfortunately would be performed emergency operation for presumed appendicitis. We are purposed to verify the usefulness of colonoscopy for the diagnosis and aimed to treat many patients with this disease conservatively. METHODS: We reviewed retrospectively the medical records of the 46 patients who diagnosed as the cecal and ascending colonic diverticulitis under admission at general surgery department during 4 years from January, 1997 to December, 2000. RESULTS: The mean age was 40.1 years and the male to female ratio was 1.2:1. Most common clinical manifestation was abdominal pain (46 cases) and nausea/vomiting (13 cases), fever/chill (4 cases) followed. On physical examination on abdomen, 26 patients had tenderness with rebound tenderness on right low quadrant and 18 patients showed only tenderness on right low quadrant. The mean peripheral WBC count was 10,600.9/mm2. Diagnostic tools were abdominal ultrasonography (34 cases), abdominal CT (13 cases), barium enema (8 cases) and colonoscopy (22 cases). The sensitivities of each modalities were 52.6%, 46.2%, 33.3% and 81.8% respectively. The respective mean hospital days depending on the treatment arms were as follows: 6.0 days of the conservatively treated group, 8.0 days of whom were operated as exploratory laparotomy with incidental appendectomy and 16.9 days of whom were operated as Right-hemicolectomy. 17 patients of 24 colonoscopy-done patients were recovered with conservative treatment, compared with only 7 patients of 22 colonoscopy-undone patients (P=0.0005). 2 cases of the conservatively managed groups were operated later due to recurrences (mean follow up periods=20 months). 2 operated patients had complications of postoperative ileus. CONCLUSIONS: Based on our study, the indications of colonoscopy are that in whom impressed clinically as acute appendicitis, on physical examination there be obvious tenderness on right low quadrant but obscure rebound tenderness, on peripheral blood smear the WBC counts range from normal to mild increased (<15,000/mm2), and on ultrasonography, appendix couldn't be detected or colonic wall show thickening. In patients who selected fit for indications, colonoscopy is safe and highly sensitive. We would manage these patients more conservatively, and may reduce their hospital stay.
Abdomen ; Abdominal Pain ; Appendectomy ; Appendicitis ; Appendix ; Arm ; Barium ; Cecum ; Colon* ; Colon, Ascending ; Colonoscopy* ; Diagnosis ; Diverticulitis ; Diverticulitis, Colonic* ; Emergencies ; Enema ; Female ; Follow-Up Studies ; Humans ; Ileus ; Laparotomy ; Length of Stay ; Male ; Medical Records ; Physical Examination ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: The Suprapubic Arc (SPARC) procedure has recently been introduced as a new surgical treatment option for stress urinary incontinence in women. We have reported our early results of SPARC procedures. MATERIALS AND METHODS: A total of 23 patients received SPARC procedures at our hospital between November 2002 and August 2003. All the patients were evaluated with history taking, physical examination, urodynamic study and cystography preoperatively. The procedure was carried out under IV propofol or spinal anesthesia. The enrolled patients were followed-up for more than 3 months postoperatively. The cure rate was evaluated and perioperative and postoperative complications were assessed. RESULTS: The mean age of the patients was 48.8 years (ranges from 32 to 67 years) and eight patients had past history of previous abdominal or pelvic surgery. The mean hospital stay was 1.9 days (ranges from 1 to 7 days). Mean follow-up period was 7.9 months (ranges from 3.7 to 14.0 months). Nineteen of the 23 patients (82.6%) were completely cured and 2 patients (8.7%) were much improved, hence the total success rate of the procedure was 91.3%. Bladder perforation during procedure occurred in 7 patients (30.4%) but conservative management sufficed. No serious complication was occurred. CONCLUSION: Our early results show that the SPARC procedure is a effective treatment option for the management of stress urinary incontinence. But we suggest that surgeons should be careful to avoid the bladder injury especially in their early period of experience.
Anesthesia, Spinal ; Female* ; Follow-Up Studies ; Humans ; Length of Stay ; Physical Examination ; Polypropylenes ; Postoperative Complications ; Propofol ; Urinary Bladder ; Urinary Incontinence* ; Urodynamics

The purpose of this study was to develop an education program for hospice care and to examine the effect of program. The education program for hospice care was developed based on the philosophy and principle of Hospice and integrated with various professional areas related to the problems with witch terminal patients and their family might be associated. The program was continued for 16 weeks and consisted of lectures and practices. The courses of this program were The Concept and Principle of Hospice, The Role of the Hospice Nurse, The Characteristics of Terminal Disease, Physical Care in Terminal Patients, Death Orientation, Psychological care for Terminal Patients, Spiritual care for Terminal Patients, and Care for the Family. To identify the effect of the education program for hospice care, the difference in death orientation of subjects between the pre and post performance of the education program was examined using the t-test. The finding of this statistic indicated that this education program for hospice care was effective in terms of changing the death orientation of subjects with positive direction. The education program for hospice care was performed several times at Kwangrim Hospice Missionary, Chungbuk University Hospital, and Wooam Church. Case studies were reported for a description after the performance of education. put this at the beginning 8 the sentence. In conclusion, the education program for hospice care was developed effectively. Therefore, this program should be used to educate and activate the subjects in community to be participants in hospice care.
Chungcheongbuk-do ; Education* ; Hospice Care* ; Hospices* ; Humans ; Lectures ; Missions and Missionaries ; Philosophy

Inflammatory linear verrucous epidermal nevus(ILVEN) is a relatively rare skin disorder, characterized by chronic inflammatory psoriasiform pattern. This chronic skin disorder is generally believed to be resistant to various treatments, although some authors have reported success with 13-cis-retinoic acid and 585 nm pulsed laser therapy. We experienced a 15-month aged female ILVEN patient who has been suffered from linear erythematous verrucous pathes mainly located on left inguinal area, hand, and foot with persistent itching sense. This skin lesion have been developed at birth, and more spread out toward right extremity after 1 year old age . We initially treated this skin lesion with topical corticosteroids and oral anti-histamines, but this treatment was not successful. So we retreated this patient with etretinate(oral retinoid) and topical 13-cis-retinoic acids, we found that therapeutic responses to these applications were more remarkable. Now, we closely observe this patient's clinical course further more.
Adrenal Cortex Hormones ; Etretinate ; Extremities ; Female ; Foot ; Hand ; Humans ; Isotretinoin ; Laser Therapy ; Nevus, Sebaceous of Jadassohn* ; Parturition ; Pruritus ; Skin

BACKGROUND AND OBJECTIVES: It has been demonstrated that the estimated infarct size is a prognostic variable which significantly influences the short-term and long-term prognosis after an acute myocardial infarction (AMI). Recently, the late peak level of troponin-T has been determined as a reliable and simple non-invasive method for estimation of infarct size. This study was performed to determine whether the late peak level of troponin-T can be used to predict cardiovascular events during in-hospital stay and out-patient follow-up in patients with AMI. MATERIALS AND METHOD: The study was comprised 100 patients (male 91, mean age 57+/-1 years) with AMI and thrombolysis which was initiated within 6 hours after the onset of symptoms. The late peak concentration of troponin-T was defined as a more larger level between 48 and 72 hours after thrombolysis. We investigated the factors influencing on the late peak level of troponin-T and assessed the relation of the late peak level and cardiovascular events. RESULTS: 1) The late peak level of troponin-T was significantly correlated with the peak creatine kinase (CK) level, (r=0.69, p=0.0001) but not ejection fraction of left ventricle (LVEF) at 7 days after AMI. The late peak level of troponin-T was significantly higher in patients with LVEF of <40% at 7 days after AMI (13.49+/-3.62 vs. 6.44+/-0.72, p=0.035) but not different by location of AMI and reperfusion status. 2) During clinical follow-up at a mean duration of 27 months, 1 cardiac death, 10 congestive heart failure, 8 recurrent infarction, and 20 post-myocardial infarction angina were occurred. 3) In patients who occurred cardiac events during in-hospital stay, the peak level of CK (4377+/-938 vs. 2661+/-234, p=0.001) and TIMI forward flow grade < 3 (5/13 vs. 6/55, p=0.022) were significantly higher, but the late peak level of troponin-T (8.69+/-1.22 vs. 6.91+/-0.79, p=0.021) and the peak level of troponin-T (21.09+/-2.29 vs. 13.28+/-1.37, p=0.021) were significantly higher in patients who occurred cardiac events during out-patient follow-up. On multi-variate analysis by logistic regression, the late peak level of troponin-T was predicted the cardiac events during clinical follow-up (CI 1.022-1.196, p=0.022). CONCLUSIONS: The late peak level of troponin-T is significantly correlated with peak CK level and higher in patients with LVEF of Creatine Kinase ; Death ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Humans ; Infarction ; Logistic Models ; Myocardial Infarction* ; Outpatients ; Prognosis ; Reperfusion ; Troponin T*

OBJECTIVES: The prognosis of spontaneous intracerebral hemorrhage often depends on initial neurologic condition, size and location of hemorrhage and associated intraventricular hemorrhage. However, age of patient, coagulation state and other associated vascular diseases may also play a role when present. In recent years, the geriatric population has been increasing. The age distribution of the patients with intracerebral hemorrhages also has been increased, accordingly. However, such patients, especially when associated with poor initial conditions often tend to be managed rather conservatively. The authors analyzed retrospectively on forty-five patients with spontaneous intracerebral hemorrhage over the seventies with poor initial condition to find out whether there exists a difference of outcome between surgery and non-surgery group. MATERIAL AND METHOD: A total of 45 patients over seventies with spontaneous intracerebral hemorrhage with Glasgow Coma Scale(GCS) 4-8 treated over last six years were included. The validity of surgical management for these patients as well as clinical variables which might have been operated on the outcome of these patients were evaluated. The Glasgow Outcome Scale(GOS) after three months was used for comparison of outcome. RESULTS: In surgical group(19 cases), mean age was 74.5 years old, mean hematoma volume 67.2ml and mean GCS score 5.7 points. In nonsurgical group(26 cases), mean age was 79.3 years old, mean hematoma volume 32.1ml, and mean GCS score 6.8 points. Mortality rate in surgical group was 47.4%(9 patients), including 2 cases of post-operative rebleeding, while that in nonsurgical group was 46.2%. However, when patients with initial GCS 4-6 points and over 30ml in hematoma volume were regrouped, mortality rate in surgical group was 46.2%, whereas mortality rate in nonsurgical group was 66.7%. CONCLUSION: It is concluded that the mortality rate is much low in surgery group with initial GCS less than 6 points and hematoma volume over 30cc. There was no significant difference of outcome in patients with basal ganglia and thalamic hemorrhage. However, surgical treatment lowered the mortality and morbidity rate in patients with subcortical and cerebellar hemorrhage.
Age Distribution ; Basal Ganglia ; Cerebral Hemorrhage* ; Coma ; Geriatrics ; Hematoma ; Hemorrhage ; Humans ; Mortality ; Prognosis* ; Retrospective Studies ; Vascular Diseases

PURPOSE: There has been great demand for indwelling stents for preventing pain, obstructive symptoms and other complications after endoscopic procedures. However, there is no consensus on the placement of a ureteral stent after an ureteroscopy. Inherent stent related problems warrant the minimum possible stenting duration without compromising the results of an ureteroscopy. A prospective randomized trial was performed to evaluate whether 3-day stenting is sufficient for ureteroscopic lithotripsy. MATERIALS AND METHODS: A total of 38 patients underwent an ureteroscopic lithotripsy. There were no severe operative complications. The patients were randomized into 2 groups; Group A: 18 patients who had an internal stent for 3 days after the ureteroscopic lithotripsy, and group B: 20 patients with a stent for 2 weeks. The ureteroscopic lithotripsies were performed with an 8Fr. or 10Fr. ureteroscope, under intravenous propofol anesthesia. Postoperative symptom questionnaires were acquired from each patient. A radiological follow-up was performed at least 4 weeks after the stent removal in all patients. RESULTS: There were no significant differences in the age, sex, stone size or usage of the instrument between the 2 groups. Of the 38 patients, 32 (84%) had discomfort associated with the indwelling stent. The most common symptom was irritative voiding symptom. There were no significant differences in the flank pain and ureteral stricture between the 2 groups. CONCLUSIONS: There was no difference between the 3-days and 2-weeks indwelling stented groups with respect to complications. Therefore, 3 days seems to be a more adequate duration for the decrease stent related complications and symptoms after an ureteroscopic lithotripsy, with no serious intraoperative complications.
Anesthesia ; Calculi ; Consensus ; Constriction, Pathologic ; Flank Pain ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Lithotripsy* ; Propofol ; Prospective Studies ; Surveys and Questionnaires ; Stents* ; Ureter ; Ureteroscopes ; Ureteroscopy

OBJECTIVE: Barbiturate coma therapy (BCT) is a useful method to control increased intracranial pressure (IICP) patients. However, the complications such as hypotension and hypokalemia have caused conditions that stopped BCT early. The complications of low dose BCT with Bispectral(TM) index (BIS) monitoring and those of high dose BCT without BIS monitoring have been compared to evaluate the efficacy of low dose BCT with BIS monitoring. METHODS: We analyzed 39 patients with high dose BCT group (21 patients) and low dose BCT group (18 patients). Because BIS value of 40-60 is general anesthesia score, we have adjusted the target dose of thiopental to maintain the BIS score of 40-60. Therefore, dose of thiopental was kept 1.3 to 2.6 mg/kg/hour during low dose BCT. However, high dose BCT consisted of 5 mg/kg/hour without BIS monitoing. RESULTS: The protocol of BCT was successful in 72.2% and 38.1% of low dose and high dose BCT groups, respectively. The complications such as QT prolongation, hypotension and cardiac arrest have caused conditions that stopped BCT early. Hypokalemia showed the highest incidence rate in complications of both BCT. The descent in potassium level were 0.63 +/- 0.26 in low dose group, and 1.31 +/- 0.48 in high dose group. The treatment durations were 4.89 +/- 1.68 days and 3.38 +/- 1.24 days in low dose BCT and high dose BCT, respectively. CONCLUSION: It was proved that low dose BCT showed less severe complications than high dose BCT. Low dose BCT with BIS monitoring provided enough duration of BCT possible to control ICP.
Anesthesia, General ; Barbiturates ; Coma ; Heart Arrest ; Humans ; Hypokalemia ; Hypotension ; Incidence ; Intracranial Hypertension ; Intracranial Pressure ; Potassium ; Thiopental