Most of the malignant tumors of the pancreas are adenocarcinomas arising from the ductal epithelium. Primary leiomyosarcoma of the pancreas, even though it is the most common sarcoma of the pancreas, is very rare. We present a case of leiomyosarcoma of the pancreas, probably primary, with metastases to the stomach, lymph nodes, and abdominal wall. A 52-year-old woman visited the hospital with vague right upper abdominal pain and weigh loss of 6 kg for 2 months. The radiological and endoscopic examination revealed that she had a large heterogeneous mass, 11 cm in size, in the pancreatic body and tail, a 4 cm-sized mass in the paraaortic area, and a 3 cm-sized polypoid mass in the stomach. Histologically, they were all similar to one another and composed of markedly pleomorphic cells. Immunohistochemical and electron microscopic studies showed definite smooth muscle differentiation of the tumor cells. Two months later, the patient underwent an excision of a new 3 cm mass in the right lower abdominal wall, showing features of well differentiated leiomyosarcoma.
Abdominal Pain ; Abdominal Wall ; Adenocarcinoma ; Epithelium ; Female ; Humans ; Leiomyosarcoma* ; Lymph Nodes ; Middle Aged ; Muscle, Smooth ; Neoplasm Metastasis ; Pancreas* ; Sarcoma ; Stomach

No abstract available.
Stevens-Johnson Syndrome*

Spinal epidural abscesses were evaluated using Gadolinium-enhanced magnetic resonance imaging (MRI) in 19 surgically and clinically confirmed cases, including 13 with tuberculous spondylitis and 6 with pyogenic spondylitis. We observed rim enhancement patterns in 10 patients and diffuse enhancement patterns in 9 patients. The spread patterns were localized to ventral or dorsal epidural space and encircled entire epidural space. We conclude that rim enhancement indicates abscess and diffuse enhancement indicates granulation tissue and fibrosis. Tuberculous epidural abscess spreads to ventral epidural space and pyogenic epidural abscess encircles entire epidural space.
Abscess ; Epidural Abscess* ; Epidural Space ; Fibrosis ; Granulation Tissue ; Humans ; Magnetic Resonance Imaging* ; Spondylitis

Purpose: This study analyzed the immediate effects of intra-abdominal pressure with visual feedback on the muscle activation of the upper trapezius and sternomastoid during natural inspiration and forced inspiration in individuals with costal respiration. Methods: The eighteen individuals with upper costal breathing pattern participated in this study. Surface electromyography was used to analyze the muscle activity of the upper trapezius and sternomastoid during natural inspiration and forced inspiration before and after intra-abdominal pressure. Results: A significant difference in muscle activation was observed with the muscle type, inspiration type, and test session (p<0.05). The muscle activities of the sternomastoid and upper trapezius decreased significantly during forced inspiration after intra-abdominal pressure training (p<0.05). On the other hand, there was no significant difference during natural inspiration in both muscles (p>0.05). A comparison of the difference between the pre-test and post-test during forced inspiration revealed the upper trapezius to be significantly larger than the sternomastoid (p<0.05). No significant difference was noted during natural inspiration (p>0.05). Conclusion The intra-abdominal pressure has positive effects on correcting the breathing patterns in individuals with costal respiration.

Purpose: This study analyzed the immediate effects of intra-abdominal pressure with visual feedback on the muscle activation of the upper trapezius and sternomastoid during natural inspiration and forced inspiration in individuals with costal respiration. Methods: The eighteen individuals with upper costal breathing pattern participated in this study. Surface electromyography was used to analyze the muscle activity of the upper trapezius and sternomastoid during natural inspiration and forced inspiration before and after intra-abdominal pressure. Results: A significant difference in muscle activation was observed with the muscle type, inspiration type, and test session (p<0.05). The muscle activities of the sternomastoid and upper trapezius decreased significantly during forced inspiration after intra-abdominal pressure training (p<0.05). On the other hand, there was no significant difference during natural inspiration in both muscles (p>0.05). A comparison of the difference between the pre-test and post-test during forced inspiration revealed the upper trapezius to be significantly larger than the sternomastoid (p<0.05). No significant difference was noted during natural inspiration (p>0.05). Conclusion The intra-abdominal pressure has positive effects on correcting the breathing patterns in individuals with costal respiration.

The paint gun is an industrial instrument which ejects paint through a small opening with pressure of l,500 to 3,000 Ib/inch. In case of the paint-gun injury, the paint penetrates through a tiny wound of skin and spreads widely along the fascial plane or tendon sheath. It destroys the tissues rapidly. Moreover, the toxicity of the paint material evokes acute inflammatory reaction which is accompanied by localized swelling, erythema, heat and sometimes generalized symptoms (i.e fever). Local toxic reaction leads to swelling, circulatory disturhance and foIlowed hy gangrene of the tissue. Sometimes tissue condition is too desperate to survive and bring about amputation unfortunately. Authors treated eleven patients of the paint gun injury f'rom March 1988 to April 1995. The paint materials were removed thoroughly via large skin incision as immediately as possible after the injury. Usually the wound is left to be open for seven to ten days and is followed by delayed primary wound closure. In our experience of three cases of delayed removal( two, five and seven days after injury), the outcomes were poor with problems of pain, sensory disturhance, limitation of finger motio, and two cases of digit amputation. On doing paint gun injection, right hand was used to hold the paint-gun and left hand was used to hold the cable. Our study showed right hands were injured mainly(nine cases). It means the paint gun injury is caused by inattention of work partner.
Amputation ; Erythema ; Fingers ; Gangrene ; Hand ; Hot Temperature ; Humans ; Paint* ; Skin ; Tendons ; Wounds and Injuries

PURPOSE: The purpose of this study was to develop and evaluate a school-based peer leader centered smoking prevention program. METHODS: Non-equivalent control group with a pre/post-test design was used. Students (n=174) in two boys' junior high schools located in D city, Korea participated with 85 being selected for the experimental group and 89 for the control group. Five sessions were given to the experimental group and a 50 minute lecture to the control group. Knowledge, attitude, non-smoking intention, and non-smoking efficacy were measured for the both experimental and control group at two weeks before the program and one month after the program was completed. Data were analyzed using chi2-test, Fisher's exact test, independent t-test and paired t-test with the SPSS 21.0 program. RESULTS: The experimental group showed higher overall knowledge, negative attitude toward smoking, and higher non-smoking intention and efficacy. After receiving the school based peer leader centered smoking prevention program scores for attitude toward smoking and non-smoking efficacy increased in the experimental group were higher than in the control group. CONCLUSION: The school-based peer leader centered smoking prevention program needs longitudinal evaluation, but from this study, there is an indication that this program can be used with junior high school students and effectively change students' attitude toward smoking and promote non-smoking efficacy.
Adolescent ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Peer Group ; *Program Evaluation ; Questionnaires ; School Health Services ; Smoking/*prevention & control ; Students/*psychology

The purpose of this study was to investigate the practice of nutrition education and perceptions for implementing nutrition education in elementary schools. In this survey, 833 dietitians, 808 principals and 3,141 teachers across the country were asked about the present status and problems as well as necessity, methods, education time, education subjects and the proper nutrition educator ratio. The results of the survey showed that only 4.2% of dietitians implemented nutrition education during regular school hours or through special activities. Many subjects responded that the reasons for not practicing nutrition education were systematic problems of lack of time due to too much food service work. Especially, many rural area dietitians responded that the reason was lack of time due to joint management and cooking. Many dietitians, principals and teachers responded that the placement of one nutrition teacher in every school is needed to resolve these problems. Other solutions suggested were the introduction of a dietitian internship, and the modernization of foodservice facilities for principals and teachers. Of those surveyed 98.4 percent of principals and 95.5 percent of teachers responded that nutrition education is urgently needed. Many subjects also responded that the first three years of elementary school are the most proper time for nutrition education and it is best that these lessons are reinforced at least once a month through discretional or special activities. Survey participants responded that the proper ratio for nutrition educators is 400-800 persons for dietitians compared to less than 400 persons for principals. In conclusion, it is hoped that this study will be able to provide a foundation of data for implementing a systematic nutrition education program by nutrition teachers in elementary school.
Cooking ; Education* ; Food Services ; Hope ; Humans ; Internship and Residency ; Joints ; Nutritionists ; Social Change

BACKGROUND: Many studies have demonstrated that nitrous oxide diffuses into the cuffs of endotracheal tubes and increases cuff volumes and pressures. Such increments of cuff pressure maybe result in damage to the trachea. We evaluated the increase of intracuff pressure, volume and the statistical significance was analyzed with personal computer. METHODS: Fourty-nine patients ranging in age 37+/-15 years, in ASA physical status class 1~2 , they were 26 males and 23 females. They divided into two groups, group I(n=25) were anesthesia with nitrous oxide : oxygen (2 L/min : 2 L/min), group II were(n=24) anesthesia with nitrous oxide : oxygen (4 L/min : 2 L/min). The cuff pressure was measured every 30 minutes and compared with each others and group I and II. RESULTS: Our results suggest that a significant intracuff volume and pressure changes developed between two groups (p<0.05), more significant intracuff pressure changes occured at group II than group I (p=0.001) and significant increment changes according to time and different concentration of nitrous oxide between two groups (p<0.05). CONCLUSIONS: This study was conducted to determine the degree of intracuff pressure and volume changes during general inhalation anesthesia with different concentration of nitrous oxide. These results suggest that a nitrous oxide significantly increases cuff pressure and volume in a concentration and time related fashion.
Anesthesia ; Anesthesia, Inhalation* ; Female ; Humans ; Inhalation* ; Male ; Microcomputers ; Nitrous Oxide* ; Oxygen ; Trachea

OBJECTIVES: Coding Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT) with complex and polysemy clinical terms may ask coder to have a high level of knowledge of clinical domains, but with simpler clinical terms, coding may require only simpler knowledge. However, there are few studies quantitatively showing the relation between domain knowledge and coding ability. So, we tried to show the relationship between those two areas. METHODS: We extracted diagnosis and operation names from electronic medical records of a university hospital for 500 ophthalmology and 500 neurosurgery patients. The coding process involved one ophthalmologist, one neurosurgeon, and one medical record technician who had no experience of SNOMED coding, without limitation to accessing of data for coding. The coding results and domain knowledge were compared. RESULTS: 705 and 576 diagnoses, and 500 and 629 operation names from ophthalmology and neurosurgery, were enrolled, respectively. The physicians showed higher performance in coding than in MRT for all domains; all specialist physicians showed the highest performance in domains of their own departments. All three coders showed statistically better coding rates in diagnosis than in operation names (p < 0.001). CONCLUSIONS: Performance of SNOMED coding with clinical terms is strongly related to the knowledge level of the domain and the complexity of the clinical terms. Physicians who generate clinical data can be the best potential candidates as excellent coders from the aspect of coding performance.
Clinical Coding ; Electronic Health Records ; Humans ; Medical Record Administrators ; Neurosurgery ; Ophthalmology ; Specialization ; Systematized Nomenclature of Medicine