OBJECTIVE: A number of preexisting clinical conditions are generally accepted as contraindications for total vaginal hysterectomy. The purpose of this study was to evaluate the validity of these contraindications. METHODS: The TVH-A group consisted of 230 patients who have undergone vaginal hysterectomy. These patients (1) had a large uterus (>280 gm), (2) were either nulliparous or had no previous vaginal delivery, or (3) had a history of previous abdominal or vaginal operation. The TVH-B group was composed of patients who did not present with any contraindications when they underwent vaginal hysterectomy. Patients of the TAH group underwent abdominal hysterectomy. The records for all patients were analyzed according to age, weight, parity, primary diagnosis, uterine weight, duration of operation, blood loss, analgesia, hospital stay, and postsurgical complications. RESULTS: No significant difference in age and weight was observed between the three groups. The average number of vaginal deliveries performed was lower in the TVH-A group. Uterine myoma, carcinoma in situ, and adenomyosis were common preoperative diagnoses in all groups. The most common contraindication for total vaginal hysterectomy in the TVH-A group was history of previous operation (54.8%); large uterus (44.8%) and nulliparity (21.3%) ranked second and third, respectively. Durations of operation, hospital stay, and pain were longer, bleeding volume was greater, and incidence of postoperative complications was higher in the TAH group than in the other groups (p<0.01). Previous cesarean delivery did not affect various operative characteristics among women undergoing vaginal hysterectomy (p<0.01). CONCLUSION: Our data indicate that a history of previous operation, large uterus, and nulliparity rarely constitute contraindications to vaginal hysterectomy.
Adenomyosis ; Analgesia ; Carcinoma in Situ ; Diagnosis ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Incidence ; Leiomyoma ; Length of Stay ; Parity ; Postoperative Complications ; Uterus

PURPOSE: This study was performed to identify the characteristic findings of miliary pulmonary tuberculosis on HRCT and to evaluate the usefulness of HRCT by compareson with chest radiographs. MATERIAL AND METHODS: High resolution CT, chest radiographs and medical records were retrospectively reviewed in 10 patients with miliary pulmonary tuberculosis. We analysed the size, distribution and margin of nodules, reticular or ground-glass density, parenchymal lesion, mediastinal lymphadenopathy and pleural effusion on HRCT which were compared with chest radiographic findings. RESULTS: On HRCT, characteristic 1--2mm sized sharp or ill-defined nodular densities were randomly distributed throughout both lungs in all cases. In seven cases, the nodules were evenly scattered, but slightly more in upper lung zone in two cases, and in lower in one case. Only three cases revealed somewhat large and abundant nodules in posterior lung zone. There were findings of ill-defined margin of nodules in three cases, reticular densities in three cases and ground-glass opacity in two cases, all of which were observed within 4 weeks after onset of symptom. In one case, HRCT scan revealed a micronodular pattern in the lung parenchyma, even though chest radiographs of 2 days before were not obviously abnormal. HRCT was better to evaluate the margin of nodule and distribution than chest radiographs in four cases. Focal parenchymal lesion (n=5), pleural effusion(n=4), mediastinal lymphadenopathy(n=6) and ARDS(n=I) were also associated. CONCLUSION: HRCT could suggest a more specific diagnosis of miliary pulmonary tuberculosis with the above characteristic findings in appropriate clinical setting and normal or interstitial pattern of chest radiographs.
Diagnosis ; Humans ; Lung ; Lymphatic Diseases ; Medical Records ; Pleural Effusion ; Radiography, Thoracic ; Retrospective Studies ; Tuberculosis, Pulmonary*

PURPOSE: The purpose of this study was to identify the effects of violence experience, emotional labor and job stress on clinical nurses' depression and to provide suggestions for improving the quality of patient care. METHODS: This research involved 257 clinical nurses who were working at an acute care hospital with at least 200 beds in S city and K province. Data were collected from May 23 to June 7 in 2014 and were analyzed using IBM SPSS version 21.0. RESULTS: The results show that 98.1% of subjects had violence experience in the past year and the violence experience included 44.4% physical threat, 37.5% verbal violence and 18.1% physical violence. The average scores were emotional labor 3.57, job stress 3.54 and depression 21.16. There were positive correlations among violence experience, emotional labor, job stress and depression (p<.01). There were also significant co-relationships between depression and violence experience (r=.21, p=.001), between depression and emotional labor (r=.48, p<.001) and between depression and job stress (r=.31, p<.001). CONCLUSION: The results suggest that it is necessary to set up guidelines for clinical nurses to manage violence, emotional labor and job stress in order to create better working environment and to improve quality of patient care.
Depression* ; Patient Care ; Violence*

No abstract available.

PURPOSE: Alveolar bone develops with tooth eruption and is absorbed following tooth extraction. Various ridge preservation techniques have sought to prevent ridge atrophy, with no superior technique evident. Collagen has a long history as a biocompatible material. Its usefulness and safety have been amply verified. The related compound, atelocollagen, is also safe and displays reduced antigenicity since telopeptides are not present. MATERIALS AND METHODS: The current study evaluated whether the Rapiderm® atelocollagen plug (Dalim Tissen, Seoul, Korea) improves tissue healing of extraction sockets and assessed the sequential pattern of bone regeneration using histology and microcomputed tomography in six beagle dogs. To assess the change of extraction socket, hard tissues were examined 2, 4, 6, and 8 weeks after tooth extraction. RESULT: The experimental groups showed better bone fill with slow remodeling process compared to the control groups although there was no statistical difference between groups. CONCLUSION: The atelocollagen seems to have a tendency to slow bone remodeling in the early phase of healing period and maintain remodeling capacity until late phase of remodeling. Also, use of atelocollagen increased the bone-to-tissue ratio compared to healing of untreated extraction socket.
Animals ; Atrophy ; Bone Regeneration* ; Bone Remodeling ; Collagen ; Dogs* ; Seoul ; Tooth Eruption ; Tooth Extraction ; X-Ray Microtomography

Since the hospital bankruptcy rate is increasing, it has been an important issue to predict the bankruptcy of hospital using the existing hospital management information. Fortunately, the implementation of data mining methodology and decision support system(DSS) are becoming popular. Therefore, this study developed the statistical software for predicting hospital bankruptcy using data mining tool. Stepwise procedures were taken as follows: 1) adopting the HGLM and Logit Models; 2) implementing the input and output processes; 3) linking to the iBITs interface, the data miming tool; and 4) evaluating the software by fitting the hospital management data in practice. The software is written in Visual C++ 5.0 under windows NT/95, and allows the interconnection with other interfaces and libraries. This program initiates encouragement of implementation of DSS models using data mining methodology, in health care fields. This kind of software will play a pivotal role in improving the efficiency and adequacy of managing health care institutions.
Bankruptcy* ; Data Mining* ; Delivery of Health Care ; Logistic Models ; Models, Statistical

A 45-year-old female visited our clinic due to sudden right leg weakness and sensory loss. Brain and spinal cord magnetic resonance imaging showed widespread cavernous malformations. Cavernous malformation in L1 spine area was accompanied by a subacute stage hematoma with perilesional edema. Sensory loss subsided after corticosteroid therapy. Usually, neurologic deficit by spinal cavernous malformation appears more chronically in the adults compared to children. Treatment options are difficult to establish in a case with multiple cavernous malformations. Identifying hemorrhagic lesions by extensive neuroimaging evaluation could be helpful to select the treatment target for cavernous malformation.
Adult ; Brain ; Central Nervous System* ; Child ; Edema ; Female ; Hematoma ; Hemorrhage ; Humans ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Neuroimaging ; Neurologic Manifestations* ; Spinal Cord ; Spine

PURPOSE: This study was conducted to explore clinical nurses' experience of positive organizational culture in order to provide data for effective strategies of acquisition and retention of competent nurses. METHODS: In this qualitative study, interviews with four focus groups of four to six nurses, 19 in total, were held. Compositional factors in groups included clinical experience, age, work place, and position. Interviews proceeded until data were saturated. RESULTS: Fifteen sub-themes, categorized into six themes, emerged. Positive organizational culture themes included "Helping nurses to be organization members", "Allowing nurses to communicate with one another", "Helping nurses take an initiative to lead organization", "Having competent leader take charge of organization", "Enabling nurses to achieve organizational changes", and "Leading nurses to accomplish organizational performance." CONCLUSION: Results indicate that positive organizational culture is related to increases in occupational satisfaction and decreases in turnover through supportive organizational culture which makes it possible to reinvest expenses required for training new members to promoting quality growth in the organization and the prestige of professional nurses. In order to improve occupational satisfaction and sustained growth in nurses, it is necessary to provide nurses with positive work environments and require members to make active efforts leading to strategic changes.
Focus Groups ; Organizational Culture* ; Workplace

PURPOSE: This study aimed to evaluate the clinical course and prognostic factors of acquired third, fourth, and sixth cranial nerve (CN) palsy grouped according to etiology. METHODS: This study involved a retrospective review of the medical records of 153 patients who were diagnosed with acquired paralytic strabismus from January 2004 to July 2015. Outcomes, recovery rates, and time to recovery were investigated according to the affected CN: CN3, CN4, and CN6 palsies. The patients were classified into four groups based on etiology: idiopathic, traumatic, neoplastic, and vascular. RESULTS: The mean age of the patients was 59.8 ± 14.5 years and the mean follow-up period was 10.8 months. Out of the 153 patients, 63 (41.2%) had CN3 palsy, 35 (22.9%) had CN4 palsy, and 55 (35.9%) had CN6 palsy. The most common causes were vascular related (54.9%), followed by idiopathic (28.1%), trauma (8.5%), and neoplasm (5.88%). About 50% of the patients recovered within six months. Among the four etiologic groups, the idiopathic group showed the best prognosis because about 50% of the patients in this group recovered within three months. This was followed by the vascular, traumatic, and neoplastic groups. Cox proportional hazard analysis revealed a significant association between the baseline prism diopter and recovery rate. CONCLUSIONS: The prognosis and natural history of paralytic strabismus vary depending on its cause. The vascular group had the best recovery rate and shortest recovery time, whereas the neoplastic group required the longest time to recover.
Abducens Nerve Diseases* ; Abducens Nerve* ; Cranial Nerve Diseases ; Follow-Up Studies ; Humans ; Medical Records ; Natural History ; Paralysis ; Prognosis ; Retrospective Studies ; Strabismus

Purpose: This study was conducted to determine the malignancy risk and diagnostic value of various types of nonshadowing echogenic foci (NEF) in the risk stratification of thyroid nodules. Methods: A total of 1,018 consecutive thyroid nodules (≥1 cm) with final diagnoses were included. The presence of NEF was determined and types of NEF were classified according to the presence of a comet tail artifact (CTA), location, and size through a prospective evaluation. The associations with malignancy, malignancy risk, and diagnostic value of various types of NEF were assessed. Results: Intrasolid punctate NEF without CTA was the only type of NEF that was an independent predictor of malignancy (P<0.001). The malignancy risk of intrasolid punctate NEF without CTA was substantially higher in solid hypoechoic nodules than in isoechoic or nonsolid nodules (71.3% vs. 9.2%, P<0.001). In solid hypoechoic nodules, slightly increased sensitivity (70.8% vs. 67.9%) for malignancy and a similar malignancy risk (71.4% vs. 71.3%) were observed for intrasolid punctate NEF (with or without CTA) and intrasolid punctate NEF without CTA, respectively. NEF with CTA at the margin of the cystic component was not associated with malignancy or benignity in nonsolid nodules (P>0.05). Conclusion Intrasolid punctate NEF without CTA was the only independent predictor of malignancy. However, solid hypoechoic nodules with intrasolid punctate NEF should be classified as high-suspicion nodules regardless of coexisting CTA. Other types of NEF had no added value for detecting malignancy compared to intrasolid punctate NEF without CTA.