PURPOSE: The purpose of this study was to identify the factors influencing parenting stress in primiparas. METHOD: The participants in this study were 198 primiparas of infants aged 1-6 months who visited well baby clinics in 5 hospitals. The data were collected from April 15 to June 15, 2003. RESULTS: The mean score for parenting stress was 2.4 of a possible 5 and thus considered average. The score for parenting stress was significantly correlated with the level of maternal perception of the infant and the level of social support. The score for parenting stress was significantly different according to the education level of the primiparas and prenatal management. For the primiparas, social support(20%) and maternal perception of the infant(9%) were significant predictors explaining parenting stress. CONCLUSIONS: Nursing interventions to improve maternal perception of the infant and increase social support should be provided for primiparas in order to reduce parenting stress.
Education ; Humans ; Infant ; Nursing ; Parenting* ; Parents* ; Child Health

Specific or non-specific cytolytic processes of free-living amoebae causing meningoencephalitis have been emphasized and the cytolytic ability related to hydrolases in Entamoeba sp. and Naegleria sp. has also been reported since the latter half of 1970's. However, no information on hydrolase activities in Acanthamoeba sp. is available. Hydrolases in Acanthamoeba culbertsoni, a pathogenic species of free-living amoebae, were assayed and compared with those in a non-pathogenic species, A. royreba. Pathogenicity of these two species was confirmed through experimental infection to BALB/c mice. Hydrolase activities and cytotoxic effects between pathogenic and non-pathogenic species were compared in the trophozoites cultured in CGV media and in CHO cell line, respectively. The results are summarized as follows: The mice infected with A. culbertsoni were all dead 15 days after nasal inoculation, and the mean survival time was 8.5 days. Also the mice infected with this pathogenic species mani fested typical meningoencephalitis, whereas the mice infected with A. royreba did not. Hydrolases detected both in the cell extracts and culture media were acid phosphatase, beta- N-acetyl galactosaminidase, beta-N-acetyl glucosaminidase, alpha-mannosidase, neutral proteinase and acid proteinase, all of which were detected with remarkably higher rate in A.culbertsoni than in A. royreba. A. culbertsoni revealed strong cytotoxicity for the target CHO cells, whereas A. royreba did not show any specific cytotoxicity. About 80 % of the target cells mixed with A. culbertsoni were dead 48 hours after cultivation, and more than 95% of the target cells were dead 72 hours after cultivation. Hydrolase activities in A. culbertsoni cultured with the target cell line were assayed according to the culture time. The activities of acid phosphatase, beta-N-acetyl glucosaminidase, beta-N-acetyl glucosaminidase, alpha-mannosidase and acid proteinase in this pathogenic amoeba were detected higher in amoeba extracts than in culture media up to 120 hours after cultivation, but after 120 hours of cultivation those activities were detected higher in culture media than in the amoeba lysates. Neutral proteinase activity in A. culbertsoni increased more in EBSS medium than in the lysate specimens although the activity in the extracts was generally steady according to the cultivation time. Summarizing the above results, it is concluded that there were differences in hydrolase activities between pathogenic A. culbertsoni and non-pathogenic A. royreba, and that some hydrolase activities were detected remarkably higher in A. culbertsoni which revealed strong cytotoxicity to the target CHO cell line.
parasitology-protozoa ; Acanthamoeba culbertsoni ; Acanthamoeba royreba ; biochemistry ; hydrolase ; acid phosphatase ; beta-N-acetyl galactosaminidase ; beta-N-acetyl glucosaminidase ; alpha-mannosidase ; neutral proteinase ; acid proteinase ; mouse ; hydrolase ; acid phosphatase ; beta-N-acetyl galactosaminidase ; beta-N-acetyl glucosaminidase ; alpha-mannosidase ; neutral proteinase ; acid proteinase

Unexpected findings of hyperamylasemia have been observed in patients with primary neurosurgical abnormalities without abdominal trauma or evidence of pancreatitis. However, the causes of hyperamylasemia in abovementioned cases have not been clearly elucidated. We have experienced hyperamylasemia in a 66 year-old female patient with subarachnoid hemorrhage caused by ruptured cerebral aneurysms who had had 2 aneurysms in right pericallosal and left middle cerebral trifurcational artery. Among the 2 aneurysms, the one in right pericallosal artery was ruptured and subarachnoid, intraventricular and intracranial hemorrhage was observed on the initial brain CT scan. There was no specific problem during operation and patient's staying in recovery room. Seven hours after the operation finished, severe hypotension and metabolic acidosis were occurred. Vital signs and acidosis were corrected with fluid and bicarbonate therapy. We incidentally found marked hyperamylasemia in the first postoperative day and serum amylase level was decreased and thereafter normalized through the seventh postoperative day. There was no evidence of acute pancreatitis on either clinical examination or radiologic study of abdominal sonography and CT scan. On the brain CT scan which was taken on the third postoperative day, the increase in the amount of hemorrhage in bilateral frontal area was found and cerebral ischemia was observed in the territory of bilateral anterior cerebral artery.
Acidosis ; Aged ; Amylases ; Aneurysm ; Anterior Cerebral Artery ; Arteries ; Brain ; Brain Ischemia ; Female ; Hemorrhage ; Humans ; Hyperamylasemia* ; Hypotension ; Intracranial Aneurysm* ; Intracranial Hemorrhages ; Pancreatitis ; Recovery Room ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed ; Vital Signs

In tracheal stenosis, airway management is most challenging for anesthesiologists. A small sized endotracheal tube, laryngeal mask airway, with high frequency jet ventilation can be used, but may result in ineffective oxygenation and ventilation. In such cases, extracorporeal life support, ECLS, can be helpful. Herein, a case of tracheal stenosis in an adult assisted with the ECLS is reported.
Adult ; Airway Management ; High-Frequency Jet Ventilation ; Humans ; Laryngeal Masks ; Oxygen ; Tracheal Stenosis* ; Ventilation

A 26-year-old male patient presented for stump revision of an amputated right 3rd finger and neurorrhaphy for a lacerated right 2nd finger. An axillary brachial plexus block was performed using the transarterial technique. Postoperatively, the patient demonstrated signs and symptoms of brachial plexus injury. He exhibited paresthesia in the distribution of the ulnar nerve and motor weaknesses the wrist, elbow, and shoulder. On the 18th postoperative day, nerve conduction and electromyographic studies were performed, which revealed possible right radial neuropathy and axillary neuropathy, or right brachial plexopathy with posterior cord involvement. After seven months of medical and physical treatment, the pain subsided but slight paresthesia and muscle weaknesses still remained. We describe a case of postoperative neuropathy, which is believed to be caused by a direct nerve injury after an axillary brachial plexus block with persistent signs and symptoms over a considerable period.
Adult ; Brachial Plexus Neuropathies ; Brachial Plexus* ; Elbow ; Fingers ; Humans ; Male ; Muscle Weakness ; Neural Conduction ; Paresthesia ; Radial Neuropathy ; Shoulder ; Ulnar Nerve ; Wrist

PURPOSE: The purpose of this study was to identify relations among the parenting stress, maternal sensitivity to infant cues, parenting environment of first-time mothers. METHOD: The participants were 194 first-time mothers of babies aged 1-6 months who visited well-baby clinics in 5 hospitals. The data were collected from April 15 to June 15, 2003. RESULTS: The parenting stress level was moderate with a mean score of 2.4(range 1-5). The parent domain and parent-child relationship domain of the parenting stress scale were significantly correlated with maternal sensitivity to infant feeding cues (r=-.178, p<.05; r=-.197, p<.01). Parenting stress was significantly correlated with childrearing environment(r=-2.19, p<.01). Parenting stress and childrearing environment were significantly different according to the educational level of the mothers and their prenatal care. CONCLUSIONS: Nursing interventions to reduce parenting stress in first-time mothers are needed to improve maternal sensitivity to infant cues and childrearing environment which foster infant development.
Child ; Child Development ; Child Rearing* ; Child* ; Cues* ; Humans ; Infant* ; Mothers* ; Nursing ; Parent-Child Relations ; Parenting* ; Parents* ; Prenatal Care ; Child Health

BACKGROUND: It is believed that the brain temperature is about 1oC higher than the peripheral temperature. However the result has been mostly obtained in normothermia patients. The objective of this study was to evaluate whether the brain and axillary temperature difference would be increased or decreased in hypothermic patients. METHODS: Sixty-six patients who underwent a craniotomy with implantation of the thermal diffusion flowmetry sensor (SABER 2000; Flowtornics, Phonics, USA) were included in this study. The temperature of the cerebral cortex and axilla were measured simultaneously every 2 hours. The patient groups were divided according to their axillary temperature, hyperthermia (over 38oC: 127 paired data), normothermia (36 38oC: 1626 paired data) and hypothermia (under 36oC: 285 paired data). A total 2048 paired sample data were collected and analyzed. RESULTS: The temperature difference between the cerebral cortex and the axilla was 0.46 +/- 1.04 oC in hyperthermic patients, 0.89 +/- 1.65 C in normothermia patients and 1.04 +/- 0.82 C in hypothermic patients. The temperature difference has statistical significance in each group (unpaired t-test, P > 0.05). CONCLSIONS: Our results demonstrate that the temperature difference in the brain shows a difference according to the patients, body temperature. In normothermia the temperature difference between the brain and the axilla was about 1oC. However in a hyperthermic state, the temperature difference decreased and in a hypothermic state, the temperature difference increased.
Axilla* ; Body Temperature* ; Brain* ; Cerebral Cortex ; Craniotomy ; Fever ; Humans ; Hypothermia ; Rheology ; Thermal Diffusion

Takayasu arteritis is a nonspecific chronic inflammatory disease of the aorta and its major branches, which has a higher incidence during the child-bearing years. There have been several reports of Takayasu arteritis during pregnancy with Cesarean delivery under general or epidural anesthesia. However, there have been few reports of successful vaginal delivery under epidural analgesia. We report a case of successful vaginal delivery under epidural analgesia in a 31-year-old primigravida with a history of Takayasu arteritis.
Adult ; Analgesia, Epidural ; Anesthesia, Epidural ; Aorta ; Humans ; Incidence ; Pregnancy ; Takayasu Arteritis

Barbiturate has been used for the therapy of increased intracranial pressure (ICP) patients. However, it has some serious side effects such as rebound response or convulsion. According to recent reports, propofol can be used for coma therapy and the therapeutic result has been satisfactory. We used propofol instead of barbiturate in coma therapy and experienced a case of rebound response. On admission day, a 20-year-old female patient received an endovascular embolization for an arteriovenous malformation (AVM) in the left occipital lobe. The next day, she went into a coma and the brain CT showed a massive intracerebral hematoma at the AVM site. The patient was transferred to the operating room for decompressive surgery. At the end of the surgery, the brain edema did not subside. The patient was infused with propofol (4 mg/kg/h) after the surgery for propofol coma therapy. During the 6 day propofol therapy, ICP was effectively controlled under 20 mmHg. After completion of the propofol coma therapy, the patient was revived enough to verbally obey. 16 hours later, ICP increased to more than 30 mmHg and the patient was reinfused with propofol. We experienced a rebound response in propofol coma therapy similar to that in barbiturate coma therapy.
Arteriovenous Malformations ; Brain ; Brain Edema ; Coma* ; Female ; Hematoma ; Humans ; Intracranial Pressure ; Occipital Lobe ; Operating Rooms ; Propofol* ; Seizures ; Young Adult

A retropharyngeal abscess is a rare complication of tracheal intubation.A case of retropharyngeal abscess after unexpected difficult tracheal intubation is presented with a review of the medical literature.A 45-year-old female patient underwent excision and biopsy of the left false vocal cord mass under general anesthesia with tracheal intubation.There was unexpected difficulty of the tracheal intubation and several trials of intubations were performed.The patient complained of pain on the left side of the neck, a sore throat, dysphagia, and chest discomfort one day postoperatively.The patient had fever of 38.7degrees C.Flexible laryngoscopy, neck X-ray, neck computed tomography, and pharyngoesophagographic studies were performed, which revealed a retropharyngeal abscess.The patient was treated with antibiotics, nil per os, nasogastric tube feeding and underwent surgery for incision and drainage of the retropharyngeal abscess under local anesthesia.The patient recovered without complications, and the patient was discharged 12 days postoperatively.
Anesthesia, General ; Anti-Bacterial Agents ; Biopsy ; Deglutition Disorders ; Drainage ; Enteral Nutrition ; Female ; Fever ; Humans ; Intubation ; Laryngoscopy ; Middle Aged ; Neck ; Pharyngitis ; Retropharyngeal Abscess ; Thorax ; Vocal Cords