The purpose of this study was to construct model of sexual adjustment in people with spinal cord injury and to determine factors that relate to sexual adjustment using methodological triangulation. A total of 134 persons who were registered members of spinal cord injury organization and admitted rehabilitation unit in the hospital were included in the study. Participants answered questionnaire concerning importance of life events, sexual concern, sexual adjustment. Qualitative data were collected through semi-structured indepth interviews from 10 individuals with spinal cord injury who were previously included in the quantitative study. Constant compatative method was used to analyze the data. The results were as follows: 1) With respect to eleven other areas of life, sex life ranked the sixth and economic status ranked the highest in terms of importance. However social life ranked the lowest among the 11areas. 2) Among seven topics related to sexuality were methods and techniques to achieve sexual satisfaction, and helping a partner cope emotionally with limitation on sexual dysfunction was the second greastest. 3) The mean score for sexual adjustment was 19.47 which can be considered. 4) A process on how individuals with spinal cord injury adjust to their changed sexual life immerged from the qualitative data. It includs 4 stages: 'stage of loss' 'stage of endeavoring' 'stage of effort' and 'stage of adjustment'. Categories showing context for the action/interaction strategies were 'steadiness' and 'rediscovery as a sexual being'. There were three factors which may stimulate the adjustment process while the others may interrupt it. Those factors included personal matters, family matters and social matters. The individuals may follow each stage step by step but may go back to the previous step depending on the outcomes of their adjustment. 5) There were three factors which may stimulate the adjustment process while the others may interrupt it. Those factors included personal matters, family matters and social matters.
Humans ; Surveys and Questionnaires ; Rehabilitation ; Sexuality ; Spinal Cord Injuries* ; Spinal Cord*

Periventricular-intraventricular hemorrhage (PV-IVH)is one of the most important neurologic lesion of the low birth weight infants. Serial neurosonographic exeaminations were performed in 113 low birth weight infants who were admitted to the neonatal intensive care unit of Presbyterian Medical Center from November 1, 1990to July 31, 1991. The results were summarized as follows: 1) The incidence of PV-IVH in the study was 54% 2) According to Papile's grading system of PV-IVH, grade I was 32.8%, grade II was 45.9%, grade IIIwas 11.5% and grade IV was 9.8%. 3) The onset of PV-IVH was within the first 7 days of life in 82%. 4) Poor activity, apnea, bradycardia and hypotension were statistically significant clinical findings associated with PV-IVH(P<0.05). 5) The risk factors associated with PV-IVH were gestational age, birth weight, hyaling membrane disease, patent ductus arteriosus and artifical ventilation. 6) The mortality of PV-IVH was 0% for grade I, 10.7% for grade II,42.9% for grade III and 83.3% for gradeIV.
Apnea ; Birth Weight ; Bradycardia ; Diagnosis* ; Ductus Arteriosus, Patent ; Gestational Age ; Hemorrhage* ; Humans ; Hypotension ; Incidence ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Intensive Care, Neonatal ; Membranes ; Mortality ; Protestantism ; Risk Factors ; Ventilation

Residual adduction of the forefoot is recognized as common sequelae of treated clubfoot. The causes of residual forefoot adduction may be metatarsus varus, talonavicular subluxation and subluxation of the calcaneocuboid joint. But, less attention has been given to subluxation of the calcaneocuboid joint. The purpose of this study was to assess the correlation between subluxation of calcaneocuboid joint and residual forefoot adduction, and to suggest the guideline of treatment for subluxation of the calcaneocuboid joint. A retrospective analysis was done by the medical records and radiographs of 48 clubfeet (thirty-four patients) that had been treated with an operation (thirty-three feet) or conservative methods (fifteen feet) at the Kang-Nam St. Mary's Hospital, between 1990 and 1995. The severity of adduction of the forefoot was determined by the angle of talo-first metatarsal. Subluxation of the calcaneocuboid joint was measured by using a grading system. And then, the forefoot adduction was categorized to mild, moderate, and severe degree according to the talo-first metatarsal angle. The average length of follow-up was eighteen months. Of the 48 feet, seventeen had no subluxation of the calcaneocuboid joint (35.4%), twenty-seven Grade I subluxation (56.3%), and four Grade 3 subluxation (8.3%) on initial radiograph. On the final radiograph, twenty-five feet had a residual adduction of the forefoot. In reviewing the distribution of the residual forefoot adduction according to the initial grade of the calcaneocuboid joint subluxation, Grade 0 subluxation had 6 forefoot adduction (35.3%), Grade I subluxation had 15 forefoot adduction (55.6%), and Grade 3 subluxation had 4 forefoot adduction (100%). Grade II calcaneocuboid joint subluxation had two severe residual forefoot adduction deformities (2 out of 4 cases) and Grade I calcaneocuboid joint subluxation had one severe residual forefoot adduction deformity (1 out of 15 cases). But, there was no severe forefoot adduction deformity in Grade 0 calcaneocuboid joint subluxation. The average angle of talo-first metatarsal was decreased in Grade 0 and Grade I subluxation, whereas it was increased in Grade II subluxation. Conclusively, we believe that there is significant correlation between the severity of subluxation of calcaneocuboid joint and residual forefoot adduction, and that the patients who have a Grade II subluxation of calcaneocuboid joint need operative correction of the subluxation of the calcaneocuboid joint.
Clubfoot* ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Humans ; Joints* ; Medical Records ; Metatarsal Bones ; Metatarsus ; Retrospective Studies

The ambulatory electrocardiographic examinations were performed in 31 patients (mean age of 59.4+/-9.3 yrs : male 16 cases, female 15 cases) with ischemic heart disease to evaluate the clinical features of ST segment more than 1 mm persisting for 45 seconds or longer. The incidence of associated disease are angina pectoris 14 cases, acute myocardial infarction 3 cases, old myocardial infarction 7 cases, hypertension 19 cases, diabetes mellitus 5 cases, cerebrovascular disease 4 cases, aortic regurgitation 2 cases, ventricular arrhythmia 1 case and chronic renal faliure 1 case. 93.7% of 252 monitored episodes of transient myocardial ischemia were silent. The incidence and duration of transient myocardial ischemia were 8.1+/-6.7 episodes/day (7.6+/-6.5episodes/day for silent myocardial ischemia, 0.5+/-0.9 episodes/day for silent ischemia, 7.6+/-14.1mins/day for symptomatic ischemia). The heart rate at the onset of ST segment depression is higher in symptomatic episode than silent episode (94.6+/-19.7 vs 82.1+/-17.4/min,. p<0.05). But duration of ST segment depression is longer in silent episode than symptomatic episode(32.4+/-97.7 vs 14.8+/-10.2/min,. p<0.01). Maximal ST segment depression was similar between silent and symptomatic episode (1.61+/-0.65 mm, 1.97+/-0.84 mm, repectively). 55.5% of silent episodes occurred during sleep or resting state and 60% of symptomatic episodes occurred during strenuous effort, exercise or eating (p<0.01). Transient myocardial ischemia developed not more frequently in the morning probably because the 24 hour Holter electrocadiographic examination was performed during hospitalization in the majority of cases.
Angina Pectoris ; Aortic Valve Insufficiency ; Arrhythmias, Cardiac ; Depression ; Diabetes Mellitus ; Eating ; Electrocardiography ; Female ; Heart Rate ; Hospitalization ; Humans ; Hypertension ; Incidence ; Ischemia ; Male ; Myocardial Infarction ; Myocardial Ischemia*

Massive blood transfusion may be defined as the acute administration of blood more than one and a half times the patient's estimated blood volume. When stored whole blood is infused, complications such as coagulation defect, volume overload, acid base disturbance and pulmonary complications will develop. Massive transfusion has been associated with the development of adult respiratory distress syndrome(ARDS) in man, and both humoral factor and microemboli have been proposed as the injurious agent in the transfused blood. WE experiecned the patient who had suffered from acute respiratory failure after the transfusion of massive amount of whole blood and managed him effectively with ventilatory support with positive end expiratory pressure under the monitoring of cardiopulmonary function via the Swan-Ganz Catheter at ICU.
Adult ; Blood Transfusion* ; Blood Volume ; Catheters ; Humans ; Positive-Pressure Respiration ; Respiratory Insufficiency

BACKGROUND: Acne is principally a disorder of adolescence. However, a number of observational studies have documented a significant degree of acne in adult women. One study found a difference in women between late-onset acne and acne that persisted from adolescence. There were significant higher sebum excretion rates among women whose acne originated during the teenage years compared with late-onset acne groups. OBJECTIVE: The purpose of this study was to examine the clinical features of patients with acne and to compare the sebum excretion rates and the density of P acnes in adult acne with that in adolescent acne. METHODS: Thirty nine patients with acne vulgaris were clinically evaluated. Sebum secretion rates were evaluated by Sebutape method. The density of P acnes counted by scrub method. RESULTS: 1. The severity grades were mild to moderate in adult acne groups, consisting with the lower acne lesion counts than that of adolescent acne groups. 2. Sebum secretion rates by Sebutape(R) method showed different patterns in two groups. The mean value in the adult acne groups was lower than that in adolescent acne groups, but not statistically significant. Chin area dominant pattern, shown in adult acne groups, were not apparent in adolescent acne groups. 3. The density of P acnes was a lower mean value in the adult acne groups, but not statistically significant. Only in adolescent acne groups, the severity grades are well correlated to the density of P acnes. CONCLUSION: Adult acne was mild to moderate in severity. Clinically, adult acne differs from adolescent acne in that the lesions are located most commonly around the chin. Sebum excretion rate was the highest in the chin area of patients with adult acne. But there was no significant difference in two groups. Also the density of P acnes was not significantly different in two groups.
Acne Vulgaris* ; Adolescent* ; Adult* ; Chin ; Female ; Humans ; Propionibacterium acnes* ; Propionibacterium* ; Sebum*

No abstract available.
Breast Neoplasms* ; Breast* ; Drug Therapy*

PURPOSE: Owing to the recommendations of the Surviving Sepsis Campaign guidelines, protocol-based resuscitation or goal-directed therapy (GDT) is broadly advocated for the treatment of septic shock. However, the most recently published trials showed no survival benefit from protocol-based resuscitation in septic shock patients. Hence, we aimed to assess the effect of GDT on clinical outcomes in such patients. MATERIALS AND METHODS: We performed a systematic review that included a meta-analysis. We used electronic search engines including PubMed, Embase, and the Cochrane database to find studies comparing protocol-based GDT to common or standard care in patients with septic shock and severe sepsis. RESULTS: A total of 13269 septic shock patients in 24 studies were included [12 randomized controlled trials (RCTs) and 12 observational studies]. The overall mortality odds ratio (OR) [95% confidence interval (CI)] for GDT versus conventional care was 0.746 (0.631-0.883). In RCTs only, the mortality OR (95% CI) for GDT versus conventional care in the meta-analysis was 0.93 (0.75-1.16). The beneficial effect of GDT decreased as more recent studies were added in an alternative, cumulative meta-analysis. No significant publication bias was found. CONCLUSION: The result of this meta-analysis suggests that GDT reduces mortality in patients with severe sepsis or septic shock. However, our cumulative meta-analysis revealed that the reduction of mortality risk was diminished as more recent studies were added.
Humans ; *Observational Studies as Topic ; *Randomized Controlled Trials as Topic ; Resuscitation/*methods ; Shock, Septic/mortality/*therapy

Nitric oxide synthases (NOSs) that catalyzed the conversion of L-arginine to nitric oxide and L-citrulline play a role in ischemic-reperfusion injury. The purpose of this study was to observe the expression patterns of nNOS, iNOS and eNOS in the rat tibialis anterior and soleus muscles after multiple cyclic episodes of ischemic preconditioning (IP). Nine weeks old male SD rats were divided into control and IP groups. The IP group was further divided into 3 groups based on cycle of IP. For IP, left commom iliac artery was occluded 3, 6 and 10 times for 5 minutes ischemia followed by 5 minutes reperfusion using rodent vascular clamps. The animals were sacrificed at 0, 3, 6, 24 and 72 hours of reperfusion and the left tibialis anterior and soleus muscles were removed. The expression of nNOS, iNOS and eNOS were examined with immunohistochemical methods and Western blot analysis. IP increased the expression of nNOS, compared with the control. In the tibialis anterior muscle, the levels of nNOS in the 3IP and 6IP were higher than that in 10IP. IP increased the expression of iNOS, compared with the control, and the levels of iNOS in tibialis anterior muscle were higher than that in soleus muscle. The level of iNOS in the 10IP was higher than those in the 3IP and 6IP. IP increased the expression of eNOS, compared with the control, and the level of eNOS in soleus muscle were higher than that in tibialis anterior muscle. At 0 and 3 hours after reperfusion, the level of eNOS in 6IP and 10IP were higer than that in 3IP. In summary, these results suggest that the ischemic preconditioning increases the expression of nNOS, iNOS and eNOS, and 10 times of ischemic preconditioning may induce ischemic injury through upregulation of iNOS. And tibialis anterior muscle is more susceptabile to ischemic injury than soleus muscle.
Animals ; Arginine ; Blotting, Western ; Humans ; Iliac Artery ; Ischemia ; Ischemic Preconditioning* ; Male ; Muscle, Skeletal ; Muscles* ; Nitric Oxide Synthase* ; Nitric Oxide* ; Rats* ; Reperfusion ; Rodentia ; Up-Regulation

Post-intubation croup and tidal volme leak during ventilator support may occur when unsuitable size of endotracheal tube is used. Malposition of endotracheal tubes(ETT) are particularly common in pediatric ICU patients, and may lead to serious complications such as inadvertent endobronchial intubation and accidental extubation. Due to the inaccuracy of physical examination for ETT placement and although there is additional time consumption and expense, the chest X-ray is still considered the gold standard for ETT position evaluation. We assessed the predetermined endotracheal tube size and the distance from the incisor to the carina according to the patient's age, weight and height. The chest X-ray was used for evaluation of these patients who were admitted to the intensive care unit of Severance Hospital Yonsei Medical Center from March to August, 1990. We divided the 430 intubated patients into two groups. Group 1 included 163 patents who were intubated by a endotracheal tube without a cuff. Group 2 included 237 patients who were intubated by a endotracheal tube with a cuff. The conclusion from our results were as follows: 1) The coefficient of determination of the endotracheal tube size, R(2), was highest according to weight, 0.40 and 0.50 in Group 1 and 2. The regression equation of endotracheal tube size using weight was Y=0.11X+3.42 and Y=0.04X+5.46 in Group 1 and Group 2. 2) The coefficient of determination of the distance from the incisor to the carina was highest according to weight 0.57 and 0.33 in Group I and 2. The regression equation of the distance from the incisor to the carina using weight was Y=0.47+10.74 and Y=0.11X+20.17.
Croup ; Humans ; Incisor* ; Intensive Care Units ; Intubation ; Physical Examination ; Thorax* ; Ventilators, Mechanical