PURPOSE: The purpose of this study was to examine obstacles and supportive behaviors perceived or experienced by clinical nurses providing care for terminally ill cancer patients. METHODS: Beckstrand's survey questionnaire was translated into Korean and verified by an expert committee and through a preliminary study. A survey that used 26 questionnaire items on obstacles and 24 on supportive behaviors, was conducted among 228 registered nurses with more than one year of experience at medical-surgical general wards in a hospital. RESULTS: The highly-perceived and frequently-experienced obstacles in providing care for terminally-ill cancer patients were related to patients' uncontrollable pain or psychologically unstable family members. The highly-perceived and frequently-experienced supportive behaviors were related to caring family members or having supportive family members. However, nurses' perceptions or experiences of multiple obstacles and supportive behaviors differed by hospital type, career length, and department. CONCLUSION: Nurses seem to be in need of training for pain management for terminal cancer patients and of family care in general. Highlyperceived and highly-experienced obstacles or highly-perceived but rarely-experienced supportive behaviors should be intervened without delay considering a hospital type or nurses' career length.
Humans ; Nurses ; Pain Management ; Patients' Rooms ; Surveys and Questionnaires ; Terminal Care ; Terminally Ill*

Recurrent parotitis, which is also known as juvenile recurrent parotitis, is characterized by a cyclic swelling of parotid glands associated with discomfort and/or pain in the absence of external inflammatory changes or progression to frank suppuration. It is usually accompanied by fever and malaise. Recurrent parotitis, following mumps, is the most common inflammatory salivary gland disease during childhood. Its etiology remains an enigma, but various etiologies have been suggested as causes, including infection, allergy, localized manifestations of systemic immunologic disorders, autoimmune diseases and hereditary or congenital abnormalities of salivary duct. Sialolithiasis may occur at any age. Its higher frequency is found between the 4th and 6th decade, but it is rare in the first decade. We currently experienced a 14-year-old boy with recurrent parotitis associated with sialolithiasis. One and a half year earlier this boy experienced right-sided parotid swelling, which subsided spontaneously over a few days. During the following year and a half period, he experienced three more short bouts of parotid swelling with mild pain, fever and malaise. The symptoms including swelling lasted from several days to 2 weeks and resolved spontaneously, independent of any treatment. Forty days ago diffuse swelling of his right parotid gland developed with pain and fever, which were more exacerbated during or after meals. Meanwhile, his left parotid gland also became swollen. Diagnosis for sialolithiasis was confirmed by sialographic findings showing the filling defect in the right parotid duct. We present a case of parotid parotitis with sialolithiasis in a child with a brief review of related literatures.
Adolescent* ; Autoimmune Diseases ; Child ; Congenital Abnormalities ; Diagnosis ; Fever ; Humans ; Hypersensitivity ; Male* ; Meals ; Mumps ; Parotid Gland ; Parotitis* ; Salivary Ducts ; Salivary Gland Calculi* ; Salivary Gland Diseases ; Suppuration

PURPOSE: The purpose of this study was to develop a system for the measurement and simulation of the TMJ movement and to analyze the mandibular movement quantitatively. MATERIALS AND METHODS: We devised patient-specific splints and a registration body for the TMJ movement tracking. The mandibular movements of the 12 subjects with facial deformity and 3 controls were obtained by using an optical tracking system and the patient-specific splints. The mandibular part was manually segmented from the CT volume data of a patient. Three-dimensional surface models of the maxilla and the mandible were constructed using the segmented data. The continuous movement of the mandible with respect to the maxilla could be simulated by applying the recorded positions sequentially. Trajectories of the selected reference points were calculated during simulation and analyzed. RESULTS: The selected points were the most superior point of bilateral condyle, lower incisor point, and pogonion. There were significant differences (P<0.05) between control group and pre-surgical group in the maximum displacement of left superior condyle, lower incisor, and pogonion in vertical direction. Differences in the maximum lengths of the right and the left condyle were 0.59+/-0.30 mm in pre-surgical group and 2.69+/-2.63 mm in control group, which showed a significant difference (P<0.005). The maximum of differences between lengths of the right and the left calculated during one cycle also showed a significant difference between two groups (P<0.05). CONCLUSION: Significant differences in mandibular movements between the groups implies that facial deformity have an effect on the movement asymmetry of the mandible.
Congenital Abnormalities ; Displacement (Psychology) ; Humans ; Incisor ; Mandible ; Maxilla ; Splints ; Temporomandibular Joint ; Track and Field

Biliary-pancreatic cancers are frequently associated with vascular invasion, as well as adjacent organ invasion, due to their biologic and anatomical characteristics. These findings preclude the curative resection of these tumors due to the high mortality and morbidity following a combined vascular resection. The object of this study was to assess the safety and the effect on survival of the combined vascular resection for patients with biliary-pancreatic malignancies through an analysis of our experience. Fifteen biliary-pancreatic cancer patients underwent curative surgery, including major vascular resection, during the period from Mar. 1993 to Oct. 1996. The risk factors such as the operative mortality, the morbidity, operative time, demand for transfusion, postoperative hospital stay, and the pathological characteristics for the 12 patients who underwent pancreaticoduodenectomy(PD) with combined vascular resection were compared with those of 75 cases who underwent a PD without vascular resection from 1993 to 1995. After resections and reconstructions of superior mesenteric and portal veins, vascular patencies were mostly well preserved, and there were no damage to the liver function. Combined vascular resection did not increase the mortality, the morbidity, the hospital stay, or the operative risk. With respect to pathologic characteristics, tumors with vascular invasion did not have more metastases to the lymph node, but did have more frequent perineural invasions and were slightly larger in size. Vascular invasion alone is not a contraindication to curative resection of biliary-pancreatic cancers and combined vascular-superior mesenteric and portal vein-resection should be considered in selected cases in which histologically curative resection is possible.
Humans ; Length of Stay ; Liver ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Operative Time ; Pancreaticoduodenectomy ; Portal Vein ; Risk Factors ; Vascular Patency ; Veins*

PURPOSE : To investigate the incidence and prevalence of C-shaped root canal using computed tomographic images of head and neck in Korean population. MATERIALS AND METHODS : Regardless of each examination purpose, randomly selected 268 examples which have serial axial computed tomographic images with 8 normal molars in maxilla and mandible were selected and investigated. Defined C-shaped root canal and we could get 82 proper image examples in view of this definition. These were detected and investigated of incidence and prevalence of C-shaped root canal. RESULTS : C-shaped root canals were found in 82 examples among 268 (30.6%) and 147 teeth. They were only found on molar area, and the highest incidence was 37.41% of left mandibular second molars, and the lowest was 2.04% of right maxillary second molars. On prevalence of tooth position, mandibular second molar was the highest, 65% of C-shaped root canal teeth and maxillary second molar was 6% the lowest. CONCLUSION : 31% of randomly selected CT images no considering check-up reason have C-shaped root canals. The C-shaped root canals of mandibular second molar are found most frequently and they are also detectable on maxilla. On Korean population, C-shaped root canals are one of conditions that have to concern with dental treatment for it appears at a high prevalence relatively.
Dental Pulp Cavity ; Head ; Incidence ; Mandible ; Maxilla ; Molar ; Neck ; Prevalence ; Tooth

There has been a dramatic increase in the number and type of procedures performed in the field of cardiac intervention in the past decade. Percutaneous intervention is becoming an increasingly recognized modality for the management of prosthetic paravalvular leakages (PVLs) in severely symptomatic non-surgical candidates. Herein, we report our experience of percutaneous closure using the Amplatzer duct occluder for a PVL in a patient who underwent tricuspid valve replacement.
Heart Valve Prosthesis ; Humans ; Septal Occluder Device ; Tricuspid Valve ; Tricuspid Valve Insufficiency

Primitive neuroectodermal tumor (PNET), which belongs to the Ewing's sarcoma (ES) family of tumors, is mainly seen in children and young adults. PNETs are extremely rare in the maxilla. Here, we report a case of PNET of the left maxillary sinus in an elderly male. Magnetic resonance imaging (MRI) revealed a slightly enhanced solid mass occupying the left maxillary sinus and infiltrating into the retroantral space. A partial maxillectomy was performed. Despite postoperative chemotherapy, follow-up computed tomography (CT) and MRI revealed a nodal metastasis in the submandibular space. Neck dissection was performed. However, the patient died 10 months after the second surgery because of distant metastasis to the liver. MRI and CT were particularly useful in detecting the extent of the tumor, recurrence, and metastasis. Further, a literature review of the previously reported PNET cases of the maxilla was carried out. In this paper, we also discuss the current approach for the diagnosis and management of these tumors.
Aged* ; Child ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver ; Magnetic Resonance Imaging ; Male ; Maxilla ; Maxillary Sinus* ; Neck Dissection ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive* ; Recurrence ; Sarcoma, Ewing ; Young Adult

PURPOSE: This study was performed to examine the effects of image filter on observer performance by counting the number of holes at each wedge step on a radiographic image. MATERIALS AND METHODS: An aluminum step wedge with 11 steps ranged in thickness from 1.5 mm to 16.5 mm in 1.5 mm increments was fabricated for this study. Each step had 10 notched holes with 1.0 mm diameter on the bottom of the step wedge which were ranged in depths from 0.1 mm to 1.0 mm in 0.1 mm increments. Digital radiographic raw images of the aluminum step wedge were acquired by using CCD intraoral sensor. The images were processed using several types of noise reduction filters and kernel sizes. Three observers counted the number of holes which could be discriminated on each step. The data were analyzed by ANOVA. RESULTS: The number of holes at each step was decreased as the thickness of step was increased. The number of holes at each step on the raw images was significantly higher than that on the processed images. The number of holes was different according to the types and kernel sizes of the image filters. CONCLUSION: The types and kernel sizes of image filters on observer performance were important, therefore, they should be standardized for commercial digital imaging systems.
Aluminum ; Noise ; Radiographic Image Enhancement ; Radiography, Dental ; Task Performance and Analysis

We experienced two cases of the intramural pregnancy, the rarest form of ectopic pregnancy and a life-threatening condition, that were successfully managed through different techniques of uterus-preserving laparoscopic surgery, thus we present these cases with a review of the literature.
Female ; Laparoscopy* ; Pregnancy* ; Pregnancy, Ectopic

BACKGROUND: Acute renal allograft rejection is not only risk factor of chronic rejection but is also a significant cause of graft loss and patient death. MMF has been shown to reduce the incidence and severity of acute rejection. METHODS: To compare the risk of acute rejection and side effects of MMF with azathioprine(AZA), a total of 108 patients, who received living transplants, were divided in two groups : MMF(n=48) and AZA group(n=60). Cyclosporin microemulsion(Neoral) and steroid were administered concomitantly to all patients. RESULTS: The MMF group was significantly lower rate of acute rejection compared with AZA group during the first 3 months after renal transplantation(14.6% vs 30.0%, p=0.005). 54.5% of patients in the MMF group and 44% in the AZA group were treated only with steroid pulsing for acue rejection. 45.5% in the MMF group, compared to 56% in the AZA group, required OKT3 or Atgam for treatment of severe acute rejection, the difference is not significant. Treatment failure occurred among 31.3% of the MMF group compared with 55% in the AZA group(p=0.013). Serum creatinine of 6 months after transplantation was significantly lower in the MMF group than in the others(1.31+/-.27 vs 1.50+/-.28 mg/dL, p=0.017). The incidence of opportunistic infection was similar in both groups. Gastrointestinal side effects were more common in the MMF group 14.6% than in the AZA group 3.3%(p=0.035), while leukopenia was more common in the AZA group 21.7% than in the MMF group 4.3%(p=0.017). CONCLUSION: MMF reduced the incidence of acute rejection without notable side effects. Long-term follow up will be needed to establish the protective effect of MMF against immunological attack.
Allografts ; Antilymphocyte Serum ; Azathioprine* ; Creatinine ; Cyclosporine ; Follow-Up Studies ; Humans ; Incidence ; Kidney Transplantation* ; Leukopenia ; Muromonab-CD3 ; Opportunistic Infections ; Risk Factors ; Transplants ; Treatment Failure