BACKGROUND: There are many documents about the hemodynamic changes according to sympathetic blockade produced by epidural anesthesia, but a few reports have addressed the effects of epidural anesthesia on renal blood flow and function. We evaluated the effects of epidural ane.sthesia on the renal blood flow and function in 6 dogs under general anesthesia. METHODS: The dogs were anesthetized with halothane 1.0-1.5 volume %, nitrous oxide 2L/min and oxygen 2L/min. Epidural catheter was inserted via 17 gauge Tuohy needle through L2-L3 intervertebral space. The abdominal wall was opened and the left renal artery was dissected to measure the blood flow with the electromagnetic flowmeter. We measured mean arterial pressure, cardiac output, central venous pressure, pulmonary capillary wedge pressure and renal blood flow at the interval of 20 minutes for 2 hours during general anesthesia (control period). Urine had been collected for the control period, and then blood was sampled for the measurement of serum creatinine concentration from the femoral artery. Under the general anesthesia, epidural anesthesia was established using 10ml of 0.5% bupivacaine, and we measured same parameters for the same time sequence as in the control period (experimental period). RESULTS: Mean arterial pressure and cardiac output decreased significantly after epidural anesthesia (p<0.05). Central venous pressure and pulmonary capillary wedge pressure were not changed comparing to those in the control period. Renal blood flow decreased significantly after epidural anesthesia (p<0.05) but creatinine clearance and urine output were maintained. CONCLUSION: renal blood flow was decreased but renal function was maintained when epidural anesthesia reduced mean arterial pressure and cardiac output.
Abdominal Wall ; Anesthesia, Epidural* ; Anesthesia, General ; Animals ; Arterial Pressure ; Bupivacaine ; Cardiac Output ; Catheters ; Central Venous Pressure ; Creatinine ; Dogs* ; Femoral Artery ; Flowmeters ; Halothane ; Hemodynamics ; Magnets ; Needles ; Nitrous Oxide ; Oxygen ; Pulmonary Wedge Pressure ; Renal Artery ; Renal Circulation*

A wide range of denomination has been used for inflammatory myofibroblastic tumor (IMT). IMT is not entirely homogeneous, even though it shows some overlapping histologic features such as haphazard proliferation of spindle cell and polymorphic chronic inflammatory cell infiltraion. The spindle cell is considered to be of myofibroblastic origin but follicular dendritic cell origin was reported recently. IMT is known as nonneoplastic, aberrant inflammatory response. However, IMT could show local invasion, recurrence, vascular invasion, and malignant transformation, and clonal characteristics and aneuploidy of IMT support the hypothesis that IMT may be a neoplastic process. In order to define the nature of spindle cell of IMT, immunohistochemical stains for smooth muscle actin (SMA), vimentin (VMT), lysozyme, S-100 protein, cytokeratin, CD21 were done. Additional immunohistochemical stains for MIB-1 for proliferating activity and LMP (latent membrane protein) for Epstein-Barr virus (EBV) were done. IMTs were composed of each 2 cases from lung, liver and lymph node and one case from common bile duct, maxillary sinus, bladder and thigh, and were histologically subclassified according to Coffin et al. Nine cases (90%) were positive for SMA and VMT, but no correlation between SMA and VMT immunoreactivity and histologic types was identified. Five cases (50%) were positive for lysozyme and S-100 protein, and histologic type III was negative for lysozyme and S-100 protein, and immunoreactivity for S-100 protein was different according to the histologic subtypes. All 11 cases were negative for CD21 and EBV LMP. MIB-1 labelling index was less than 1% in all cases. In summary, the spindle cell is regarded as myofibroblastic origin rather than follicular dendritic cell origin. Relationship with EBV is not clear, and negligible MIB-1 reaction suggests that IMT might have a good prognosis.
Actins ; Aneuploidy ; Coloring Agents ; Common Bile Duct ; Dendritic Cells, Follicular ; Herpesvirus 4, Human ; Immunohistochemistry ; Keratins ; Liver ; Lung ; Lymph Nodes ; Maxillary Sinus ; Membranes ; Muramidase ; Muscle, Smooth ; Myofibroblasts* ; Prognosis ; Recurrence ; S100 Proteins ; Thigh ; Urinary Bladder ; Vimentin

To identify strategies to prevent sexual problems in teenage girls, respondents in this study answered two open-ended questions: "What are strategies for teenage school girls to prevent unwanted coitus?" and "What are strategies for teenage girls to prevent pregnancy?" The respondents were 12,733 girls from an accessible population of 19,000, a multi-stage cluster sample from a population of 1,988,902 girls attending 4,684 schools in the seven largest cities and nine provinces in Korea. Data were collected by mail between October 2 and October 28, 2000. The response rate was 68.9%. The total number of responses for the first question was 10,345, and for the second, 9,624. Data were analyzed by content analysis. The results of this study are: 1. According to priority, frequent strategies to prevent unwanted coitus were, self assertiveness (35.7%), heterosexual interaction training (24.6%), sex education (21.2%), and innovations in the system of social culture (4.7%). The order of priority was the same whether the respondents had experienced coitus or not. 2. According to priority, frequent strategies to prevent pregnancy were, heterosexual interaction training (27.4%), sex education (26.2%), contraceptive use and induced abortion (21.4%), and innovations in the system of social culture (3.2%). The first priority for the respondents who had not experienced coitus was heterosexual interaction training (27.7%) but contraceptive use (35.5%) was the first priority for the group who had experienced coitus. In sex education, a focus on contraceptive use for teenage girls who have experienced coitus and on heterosexual interaction training for those who have not, would strengthen preventive strategies for these two sexual problems. Assertiveness training as part of sex education would further strengthen prevention strategies.
Abortion, Induced ; Assertiveness ; Coitus ; Surveys and Questionnaires ; Female* ; Heterosexuality ; Humans ; Korea* ; Postal Service ; Pregnancy ; Sex Education

No abstract available.
Leukemia, Hairy Cell*

STATEMENT OF PROBLEM: The importance of fixture design and surface treatment. PURPOSE: The clinical success of dental implants is affected by many factors such like as degree of osseointegration, the effective load dispersion for the prostheses, and a lot of attempts have been made to overcome the difficulties. In this study, efforts were made to find the possibility of clinical acceptance of the dental implants of newly designed surface and resorbable blast media surcace. MATERIALS AND METHODS: In this study, two groups of custom-made, screw-shaped implants were prepared. Tthe first with the consisting of Branemark clone design and the other with the new design. These implants were divided into four groups according to the kinds of surface treatment. Four implants(AVANA., Osstem, Busan, Korea) of each group were installed in twenty rabbits. Group A was consisted of Branemark clone implant left as machined, Group B with Branemark clone implants with RBM(Resorbable blast media) surface, Group C with newly designed implants left as machined and Group D with newly designed implants with RBM surface. One of the twenty rabbits died from inflammation and the observation was made for six weeks. Specimens from four groups were observed using scanning electron microscopy with 40, 100, 1000 magnification power and microsurface structures were measured by white-light scanning interferometry for three dimensional surface roughness measurements(Accura 2000., Intek-Plus, Korea.). Removal torque was measured in 17 rabbits using digital torque gauge(MGT 12R, Mark-10 corp., NY, U.S.A.) immediately after the sacrifice and two rabbits were used for the histologic preparation(EXAKT 310., Heraeus Kulzer, Wehrheim, Germany) of specimens and observed under light microscope. Resonance frequency measurement(Osstell(R)) was taken with the 19 rabbits at the beginning of the implant fixation and immediately after the sacrifice. RESULTS: Following results were taken from the experiment. 1. The surface of the RBM implants as seen with SEM had rough and irregular pattern with reticular formation compared to that of turned specimens showing different surface topographies. 2. The newly designed implant with RBM surface had high removal torque value among four groups with no statistical significance. The average removal torque was 49.95+/-6.70Ncm in Group A, 51.15+/-4.40Ncm in Group B, 50.78+/-9.37Ncm in Group C, 51.09+/-4.69Ncm in Group D. 3. The RFA values were 70.8+/-4.3Hz in Group A, 71.8+/-3.1Hz in Group B, 70.9+/-2.5Hz, 72.7+/-2.5Hz in Group D. Higher values were noted in the groups which had surface treatment compared to the untreated groups with no statistical significance. 4. The results from the histomorphometric evaluation showed a mean percentage of bone-toimplant contact of 45+/-0.5% in Group A, 55+/-3% in Group B, 49.5+/-0.5% in Group C, and 55+/-3% in Group D. Quite amount of newly formed bone were observed at the surface RBM-treated implants in bone marrow space.
Bone Marrow ; Busan ; Clone Cells ; Dental Implants ; Inflammation ; Interferometry ; Microscopy, Electron, Scanning ; Osseointegration ; Prostheses and Implants ; Rabbits ; Reticular Formation ; Tibia* ; Torque*

PURPOSE: Accurate clinical diagnosis of acute appendicitis is more difficult in children since they may not be able to communicate their complaints adequately, and findings on physical examination may be nonspecific.The uncertainty in diagnosis may lead to a delay of surgery or to unnecessary laparotomy. Prompt diagnosis is important due to their complications such as perforation, abscess formation, and peritonitis. The authors conducted this study in order to find out usefulness of ultrasonography in diagnosis of acute appendicitis in children. METHODS: The authors was performed ultrasonographical examination to 290 children with abdominal pain under the age of 15 during a recent 16-months period from January 1994 to April 1995. High-resolution ultrasonography was used according to the graded compression method. The ultrasonographic findings were correlated with pathologic outcome in 87 cases. RESULTS: 1) Among 290 patients with abdominal pain, acute appendicitis was 81 cases (27.9%), and there were mesenteric lymphadenitis, terminal ileitis, intussusception, acute gastroenteritis, and nonspecific findings. 2) Sex ratio of acute appendicitis was 1.53:1. The acute appendicitis was occurred 13.6% in under the age of 5 and 86.4% in over the age of 6. Mean age was 10.6 3) The most frequent symptom was abdominal pain followed by vomiting, fever, nausea, and diarrhea. 4) Leukocytosis (>10,000/cu.mm) was occurred in 71 of 81 (87.7%) cases of acute appendicitis and 24 of 28 (85.7%) cases of acute appendicitis with perforation. 5) The perforation rate was higher in delayed diagnosis and in younger children. 6) Ultrasonography had a sensitivity of 97.5%, specificity of 96.2%, positive predictive value of 90.8%, and negative predictive value of 99.0% on diagnosis in acute appendicitis. CONCLUSIONS: Upon the above results, the authors were able to conclude that graded compression ultrasonography had high sensitivity and specificity and was useful for the diagnosis of acute appendicitis in children. And the ultrasonography can be applied as rapid, noninvasive, and well-tolerated investigation. So, it has diagnostic value as screening test in children whose chief complaint is abdominal pain.
Abdominal Pain ; Abscess ; Appendicitis* ; Child* ; Crohn Disease ; Delayed Diagnosis ; Diagnosis* ; Diarrhea ; Fever ; Gastroenteritis ; Humans ; Intussusception ; Laparotomy ; Leukocytosis ; Mass Screening ; Mesenteric Lymphadenitis ; Nausea ; Peritonitis ; Physical Examination ; Sensitivity and Specificity ; Sex Ratio ; Ultrasonography* ; Uncertainty ; Vomiting

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become a one of the most important causes of nosocomial infections, and use of vancomycin for the treatment of MRSA infection has increased. Unfortunately, vancomycin-resistant enterococcus have been reported, as well as vancomycin-resistant S. aureus. Arbekacin is an antibacterial agent and belongs to the aminoglycoside family of antibiotics. It was introduced to treat MRSA infection. We studied the clinical and bacteriological efficacy and safety of arbekacin compared to vancomycin in the treatment of infections caused by MRSA. MATERIALS AND METHODS: This was a retrospective case-control study of patients who were admitted to tertiary Hospital from January 1st, 2009 to December 31st, 2010, and received the antibiotics arbekacin or vancomycin. All the skin and soft tissue MRSA infected patients who received arbekacin or vancomycin were enrolled during the study period. The bacteriological efficacy response (BER) was classified with improved and failure. The improved BER was defined as no growth of MRSA, where failure was defined as growth of MRSA, culture at the end of therapy or during treatment. Clinical efficacy response (CER) was classified as improved and failure. Improved CER was defined as resolution or reduction of the majority of signs and symptoms related to the original infection. Failure was defined as no resolution and no reduction of majority of the signs and symptoms, or worsening of one or more signs and symptoms, or new symptoms or signs associated with the original infection or a new infection. RESULTS: Totally, 122 patients (63/99 in arbekacin, 59/168 in vancomycin group) with skin and soft tissue infection who recieved arbekacin or vancomcyin at least 4 days were enrolled and analysed. The bacteriological efficacy response [improved, arbekacin vs vancomycin; 73.0% (46/63), 95% confidence interval (CI) 60.3 to 83.4% vs 83.1% (49/59), 95% CI 71.0 to 91.6%] and clinical efficacy response [improved, arbekacin vs vancomycin; 67.2% (41/61), 95% CI 52.0 to 76.7% vs 78.0% (46/59), 95% CI 65.3 to 87.7%] were similar between the two groups (P=0.264, 0.265). The complication rate was significantly higher in the vancomycin group [29/59(49.2%), 95% CI 35.9 to 62.5%] than arbekacin [10/63(15.9%), 95% CI 8.4 to 29.0%] (P<0.001). CONCLUSIONS: Arbekacin could be considered as an alternative antibiotics for vancomycin in skin and soft tissue infection with MRSA. However, further prospective randomized trials are needed to confirm this finding.
Anti-Bacterial Agents ; Case-Control Studies ; Cross Infection ; Dibekacin ; Enterococcus ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Skin ; Soft Tissue Infections ; Tertiary Care Centers ; Vancomycin

No abstract available.
Histiocytic Necrotizing Lymphadenitis* ; Lymphohistiocytosis, Hemophagocytic*

PURPOSE: In this study effects of a flipped learning-based psychiatric nursing practicum were evaluated for appropriateness with undergraduate nursing students who are digital natives and tech-savvy millennial students. METHODS: For this retrospective comparative study data from 146 undergraduate students (flipped learning group n=70, traditional learning group n=76) were evaluated for academic performance and life core competencies. RESULTS: There was no significant difference between the flipped and traditional learning groups in prior homogeneity tests. The academic performance of the flipped learning group was higher than the control group in all aspects, except for practical quiz scores. The flipped leaning group had significantly higher self-assessment scores for academic performance (t=2.77, p=.006) and therapeutic communication simulation scores (t=3.18, p=.002). In addition, they showed a significant increase in core life competencies after participating in the flipped-learning practicum (t=-8.56, p<.001). They showed significant increases in all subdomains except Identity-value [Socialization (t=-5.13, p<.001), Responsibility-practice (t=-3.52, p=.001), Problem-solving (t=-2.67, p=.010), Knowledge-construction (t=-2.48, p=.016), and Information-management (t=-5.54, p<.001)]. Nursing students in the flipped learning-based clinical practicum showed significant improvement in performance and life core competencies. CONCLUSION: These results suggest that as a student-centered pedagogy, flipped learning is an effective strategy for improving academic performance and core competencies.
Education, Nursing ; Humans ; Learning ; Population Groups ; Preceptorship ; Problem-Based Learning ; Psychiatric Nursing* ; Retrospective Studies ; Self-Assessment ; Students, Nursing ; Teaching

Since the 1970s, the average life expectancy of Koreans has been increasing. Our concerns are not simply about longevity, but also about disability-free life. lately, Sasang constitutional medicine has attracted public attention, especially with respect to the elderly. The purpose of this study was to investigate the food habits, nutrients intake, and disease distribution among the elderly, according to their Sasang constitutions. The results are as follow : The distribution of constitutions of the subjects were Tae-eum 48.8%, So-yang 27.4%, So-eum 22.6%, and So-yang + So-eum 1.2%. In both elderly men and women, body weight, percent ideal body weight, and diastolic pressure of the Tae-eum were significantly higher than those of other constitutions. In both men and women, the level of hemoglobin in the Tae-eum was significantly higher than those of other constitutions. The level of LDL-cholesterol was higher, and the level of HDL-cholesterol was lower in the So-eum elderly women. Food habits of the So-eum were the most irregular, and nutrients intake of the So-eum was lower than that of other constitutions in both elderly men and women. In elderly men, the incidence of hypertension was the highest in the Tae-eum, and the incidence of gastritis was the highest in both So-yang and So-eum. In elderly women, the incidence of fatty liver was the highest in the Tae-eum and So-yang, and gastritis and hypertension were the highest in the So-eum. In the elderly, obese and anemic persons were significantly more in the Tae-eum and the So-eum, respectively. The results of this study showed that there were significant differences of physical, characeristics, food, habits, and distributions of disease for the subjects according to each Sasang constitutions. Intake of nutrient was poor, regardless of Sasang constitutions, in both men and women.
Aged* ; Blood Pressure ; Body Weight ; Constitution and Bylaws* ; Fatty Liver ; Female ; Food Habits* ; Gastritis ; Humans ; Hypertension ; Ideal Body Weight ; Incidence ; Life Expectancy ; Longevity ; Male