We report a case of mucinous cystadenoma of uncertain malignant potential and carcinoid of appendix associated with bilateral mucinous cystadenoma of ovary and pseudomyxoma peritonei. The patient was a 46-year-old female. She suffered from dyspnea and lower abdominal palpable masses for several months. Ultrasonogram showed multilocular huge ovarian cysts. Appendectomy, transabdominal hysterectomy, bilateral salphingo-oophorectomy and biopsy of omentum were performed. The bilateral ovaries measured 16 11 cm and 7X5 cm in size, respectively. The both ovaries showed multilocular cysts filled with thick mucus material. The ovarian cysts were covered by a single layer of columnar epithelium with focal proliferation. Mucus materials dissected through the ovarian stroma (pseudomyxoma ovarii). The tip of appendix was dilated and covered by mucus material. The cut surface showed a cyst and a yellowish solid mass proximal to the cyst. Microscopically, the appendiceal cyst was lined by stratified columnar epithelium with moderate cytologic atypia. Mucus material dissected through the wall. In the proximal portion of the appendix, a classic carcinoid with focal tubular form was present in submucosa and muscle layer. The omentum was covered by thick mucus material. Microscopically, the omentum showed mucinous epithelium and mucus material (pseudomyxoma peritonei).
Appendectomy ; Appendix* ; Biopsy ; Carcinoid Tumor* ; Cystadenoma, Mucinous ; Dyspnea ; Epithelium ; Female ; Humans ; Hysterectomy ; Middle Aged ; Mucins* ; Mucus ; Omentum ; Ovarian Cysts ; Ovary* ; Pseudomyxoma Peritonei* ; Ultrasonography

We report a case of mucinous cystadenoma of uncertain malignant potential and carcinoid of appendix associated with bilateral mucinous cystadenoma of ovary and pseudomyxoma peritonei. The patient was a 46-year-old female. She suffered from dyspnea and lower abdominal palpable masses for several months. Ultrasonogram showed multilocular huge ovarian cysts. Appendectomy, transabdominal hysterectomy, bilateral salphingo-oophorectomy and biopsy of omentum were performed. The bilateral ovaries measured 16 11 cm and 7X5 cm in size, respectively. The both ovaries showed multilocular cysts filled with thick mucus material. The ovarian cysts were covered by a single layer of columnar epithelium with focal proliferation. Mucus materials dissected through the ovarian stroma (pseudomyxoma ovarii). The tip of appendix was dilated and covered by mucus material. The cut surface showed a cyst and a yellowish solid mass proximal to the cyst. Microscopically, the appendiceal cyst was lined by stratified columnar epithelium with moderate cytologic atypia. Mucus material dissected through the wall. In the proximal portion of the appendix, a classic carcinoid with focal tubular form was present in submucosa and muscle layer. The omentum was covered by thick mucus material. Microscopically, the omentum showed mucinous epithelium and mucus material (pseudomyxoma peritonei).
Appendectomy ; Appendix* ; Biopsy ; Carcinoid Tumor* ; Cystadenoma, Mucinous ; Dyspnea ; Epithelium ; Female ; Humans ; Hysterectomy ; Middle Aged ; Mucins* ; Mucus ; Omentum ; Ovarian Cysts ; Ovary* ; Pseudomyxoma Peritonei* ; Ultrasonography

PURPOSE: To evaluate mammographic and sonographic breast parenchymal changes and the risk of breast cancer in women on hormonal replacement therapy (HRT). MATERIAL AND METHODS: The study group consisted of 50 patients examined with serial mammograms and/or ultrasonograms during HRT. The control group consisted of 50 patients examined with serial mammogram for a routine health check. Mammographic parenchymal changes in both the study and control groups and so- nographic findings of 27/50 patients in study group were evaluated. RESULTS: Follow-up mammogram of the control group showed no interval change or slight evolution of parenchyma with increasing age, but the study group showed increasing parenchymal densities. Most frequently encountered finding on SOhogram in 11 women treated by estrogen alone, was ductal dilatation (7cases ;64%), whereas in 16 women treated by estrogen and progesteron it was ductal epithelial hyperplasia (8 cases; 50%). Overall, four breast cancers developed;one infiltrating ductal carcinoma and three ductal carcinoma in situ. CONCLUSION: HRT causes the changes of breast parenchyma on mammogram and sonogram of postmenopausal women, and increases the risk of developing breast cancer. Therefore, careful and regular examination should be followed in those on postmenopausal HRT.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Dilatation ; Estrogens ; Female ; Follow-Up Studies ; Humans ; Hyperplasia ; Ultrasonography

BACKGROUND: Direct observation of healthcare workers is commonly used in hospitals to investigate hand hygiene compliance. However, the hand hygiene compliance rate may increase due to the Hawthorne effect, which is the modification of behavior simply because subjects become aware that they are being observed. The objective of this study was to investigate the occurrence of the Hawthorne effect when directly observing hand hygiene compliance in intensive care unit (ICU) healthcare personnel. METHODS: A total of 87 staff members from the coronary care unit and cardiac surgery ICU of a general hospital in Seoul were included in this study: 24 residents and interns, 55 nurses, and 8 nursing assistants. Both covert and overt observations, where subjects were either unaware or aware of any direct observation, were performed on separate occasions. RESULTS: A total of 1,052 covert and 1,336 overt observations were documented over 30 and 34 occasions, respectively. Overall hand hygiene compliance was significantly higher with overt observation than with covert observation (1,041/1,336, 77.9% vs. 659/1,052, 62.6%, P<0.001). The Hawthorne effect was present in all professions and behaviors, with the exception of nursing assistants, and prior to touching a patient. CONCLUSION: Direct observation of hand hygiene compliance was associated with the Hawthorne effect when observations were made overtly and this was likely to contribute to an overestimation of compliance rate.
Compliance ; Coronary Care Units* ; Delivery of Health Care* ; Effect Modifier, Epidemiologic* ; Hand Hygiene* ; Health Personnel ; Hospitals, General ; Humans ; Intensive Care Units* ; Nursing ; Seoul ; Thoracic Surgery*

Henoch-Schonlein purpura(HSP) is a systemic small vessel vasculitis characterized by cutaneous purpura, arthritis, abdominal pain and nephritis. The characteristic rash of HSP consists of palpable purpura on the buttocks and lower extremities. Bullous lesions often appear in adults with HSP, whereas they are very rare in children with HSP. In this case report, the patient presented with arthralgia and abdominal pain and had hemorrhagic bullae as a prominent manifestation of the disease. The skin biopsy of the patient revealed typical leukocytoclastic vasculitis of dermal vessels and prominent IgA and fibrinogen deposits on capillary walls by direct immunofluorescence. We confirmed the diagnosis of HSP and observed improvement of clinical symptoms and signs within a few days after corticosteroid treatment. We therefore report a case with a review of the literature.
Abdominal Pain ; Adult ; Arthralgia ; Arthritis ; Biopsy ; Blister ; Buttocks ; Capillaries ; Child* ; Diagnosis ; Exanthema ; Fibrinogen ; Fluorescent Antibody Technique, Direct ; Humans ; Immunoglobulin A ; Lower Extremity ; Nephritis ; Purpura ; Purpura, Schoenlein-Henoch* ; Skin ; Vasculitis

PURPOSE: This study was performed to evaluate prognostic significance of Rb and p53 protein immunostaining in renal cell carcinoma. We investigated correlations between Rb, p53 immunostaining and nuclear grade and stage as prognostic factors of renal cell carcinoma. MATERIALS AND METHODS: Subjects of this study were sixty-nine cases of renal cell carcinoma. We used indirect immunohistochemical methods in the formalin-fixed paraffin- embedded tissue (Rb: Pharmingen, USA; p53: Novocastra, UK). In staging and nuclear grading of the renal cell carcinoma, the American Joint Commitee on Cancer (AJCC) TNM system and Fuhrmans grading system were applied respectively. RESULTS: According to Fuhrmans grading system, four cases were classified grade I, 15 cases were classified grade II, 13 cases were classified grade III, and 37 cases were classified grade IV. By AJCC TNM staging system, 29 cases were grouped stage I, 20 cases were grouped stage II, 15 cases were grouped stage III and five cases were grouped stage IV. In 55 cases (79% of all cases), Rb protein was expressed. Expression of Rb protein did not correlate with nuclear grade nor tumor stage. p53 protein was expressed in 17 cases (24% of all cases). p53 protein expression was frequently detected in high nuclear grade group (p < 0.05), but was not correlated with tumor stage. CONCLUSION: Expression of Rb protein was not conelated with nuclear grade and stage. And expression of p53 protein was not correlated with stage, but it is correlated with nuclear grade. Thus immunohistochemical examinstion of p53 could be a histological prognostic factor.
Carcinoma, Renal Cell* ; Joints ; Neoplasm Staging ; Prognosis ; Retinoblastoma Protein

We studied 21 neonates who required mechanical ventilation during study period in NICU OF Il Sin Christian Hospital with diagosis of prematurity, IRDS, pneumothorax and diaphragmatic hernia to evaluate the accuracy of pulse oximeter in predicting the arterial oxygen saturtion, hypoxia and hyperoxemia. We also studied whether the changes of birth weight, hematocrit, blood pressure and body temperature affect the accuracy of pulse oximeter. The results are 1) Linear regression analysis revealed a close correlation between in vivo pulse oximeter readings and in vitro SaO2 measurements in patients (Y=0.008X+12.34, r=0.946) 2) The changes of birth weight, hematocrit, blood pressure and body temperature did not affect the accuracy of pulse oximeter. 3) SpO2-PaO2 relationship was similar to the SsO2-PaO2 relationship. 4) When Nellcor N-100 pulse oximeter was setted at alarm limit 96% to avoid hyperoxemia, it identified 16 of 22 hyperoxemic instances (sensitivity 73%) and alarmed falsely in 48 of 92 nonhyperoxemic instances (specificity 59%).
Anoxia ; Birth Weight ; Blood Pressure ; Body Temperature ; Hematocrit ; Hernia, Diaphragmatic ; Humans ; Infant, Newborn ; Linear Models ; Oxygen* ; Pneumothorax ; Reading ; Respiration, Artificial

PURPOSE: Our purpose was to deterrnine the efficacy of maternal corticosteroid therapy on the morbidity of premature infants between 26 and 31 weeks' gestation. METHOD: A total of 62 premature infants between 26 and 31 weeks gestation admitted to pediatric department of National Medical Center from Nov, 1990 to June 1996 were analyzed to evaluate the efficacy of prenatal corticosteroid therapy on the morbidity such as hyaline membrane disease, intreventricular hernorrhage, necrotizing enterocolitis, sepsis, neonatal death, days on ventilation and hospital days. RESULT: Among 62 women who delivered premature infants between 26 and 31 weeks, 22 received betamethasone before delivery and 40 did not. 1) The rate of hyaline membrane disease was less in the betamethasone group (41% vs. 70%, P<0.05). 2) The rate of intracranial hemorrhage was less in the betamethasone group (0 vs. 20%, P<0.05). 3) The days of ventilator care was less in the betamethasone group among survival cases (27+/-3.2 vs. 5.2+/-4.6, P<05). 4) Arnong 14 women who delivered at 26 to 28 weeks, 4 received betamethasone before delivery and 10 did not. The rate of neonatal death was less in the betamethasone group (o% vs. 80%, P<0.05). 5) Among 48 women who delivered at 29 to 31 weeks, 18 received betamethasone before delivery and 30 did not. The rate of hyaline membrane disease was less in the betamethasone group (39% vs. 73%, P<0.05). CONCLUSION: Betamethasone appears to reduce hyaline membrane disease, intraven- tricular hemorrhage, neonatal death and the morbidity significantly in premature infants between 26 and 31 weeks' gestation.
Betamethasone ; Enterocolitis, Necrotizing ; Female ; Hemorrhage ; Humans ; Hyaline Membrane Disease ; Infant, Newborn ; Infant, Premature* ; Intracranial Hemorrhages ; Pregnancy ; Sepsis ; Ventilation ; Ventilators, Mechanical

This study was intended to examine the zinc status and effect of zinc supplementation on the zinc nutritional status of the elderly living in the Ulsan area. The zinc intake of 207 subjects(male 97, female 110) was measured by a 24-hour dietary recall and food frequency method. Biochemical analysis were conducted from blood and urine samples to evaluate the changes of zinc nutriture with zinc supplementation. The average dietary zinc intake of subjects was 7.7+/-2.8 mg for male and 7.5+/-2.6 mg for female, which were 51.3% and 62.3% of Korean RDA respectively. The first source of zinc was cereal and grain(36%), and the second was eggs and milk group(27%). After 8 weeks of zinc supplementation, the serum zinc content was significantly increased(p<0.01), although the serum copper content was not significantly decrease. Serum HDL-cholesterol level was not significantly decreased with zinc supplementation. Serum alkaline phosphatase(ALP) activity and urinary zinc excretion were significantly increased(p<0.05). The urinary Zn/Cr was not significantly increased. It is suggested from the results that the daily zinc supplementation can be effective to improve zinc nutriture.
Aged* ; Edible Grain ; Copper ; Eggs ; Female ; Humans ; Male ; Milk ; Nutritional Status ; Ovum ; Ulsan* ; Zinc*

PURPOSE: The purpose of this study was to examine the effects of preoperative pain management education on postoperative pain control in patients with uterine tumor using patient controlled analgesia. METHODS: This study used non-equivalent control group non-synchronized design. Data were collected from September, 2008 to March, 2009 at one university hospital in Daegu, Korea. There were 60 participants, 30 in both the experimental and control group. The experimental group was given preoperative pain education using videos, leaflets, and a PCA model. Postoperative pain intensity, frequency of the PCA button being pressed, and doses of additional analgesics were observed through 24 hours postoperative and knowledge of pain and attitude about the use of the pain medicine were measured at 3 days postoperative. Collected data were analyzed using t-test, chi2 test, repeat measured ANOVA, and Bonferroni methods. RESULTS: There were no significant differences in the postoperative pain level between the experimental and control group. Postoperative frequency of the PCA button pressed, doses of additional analgesics, pain knowledge and attitude about the use of the pain medicine of the experimental group were significantly higher than those of the control group. CONCLUSION: Pain management education is an effective nursing intervention for pain control after surgery.
Analgesia ; Analgesics ; Humans ; Korea ; Pain Management ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis