We report a case of a 44 year old femele with unilateral aldosterone-proudcing adrenal adenoma characterized by hypertension, plasma aldosterone excess, and low plasma renin, commonly but not invariably with hypokalemia. She also had asymmetric septal hypertrophy of left ventricle established with two-dimensional echocardiography. The electrocardiogram showed inverted T wave and prominent U wave with high QRS voltage on precordial leads. In the case of this patient, we are not sure whether asymmetric septal hypertrophy was caused by secondary hypertension and chronic aldosterone excess of primary aldosteronism, or hypertrophic cardiomyopathy per se, so further long=term follow-up is required to determine it. Following the successful unilateral adrenalectomy, however, the systemic pressure fell down to the normal level and electrolyte abnormalities were corrected immediaterly within a few days and the modest regression in septal hypertrophy was noted in one year, suggesting that the promary aldosteronism contributes to the development or porgression of asymmetric septal hepertrophy.
Adenoma ; Adrenalectomy ; Adult ; Aldosterone ; Cardiomyopathy, Hypertrophic* ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Heart Ventricles ; Humans ; Hyperaldosteronism* ; Hypertension ; Hypertrophy ; Hypokalemia ; Plasma ; Renin

BACKGROUND: Most current reseatch using prognostic scoring systems in critically ill patients have focused o prediction using the first intensive care unit(ICU) day data or daily updated data. Usually the mean ICU length of stay in Korea is longer than in the western world. Consequently, a more cost-effective and practical prognostic parameter is required. The principal aim of this study was to assess the prognostic value of the seventh day(7th day : the average mean ICU length of stay) APACHE III score in a medical intensive care unit. METHODS: 241 medical ICU patients from July 1997 to April 1998 were enrolled. The 1st and 7th scores were measured by using the APACHE III scoring system and compared between survivors and non-survivors. Logistic regression analysis was performed to determine the relationship between the 1st and 7th APACHE III scores and the mortality risk. RESULTS: 1) The mean length of stay in the ICU was 10.3±13.8 days. 2) The mean 1st and 7th day APACHE III scores were 59.7±30.9 and 37.9±27.7. 3) The mean 1st day APACHE III scores was significantly lower in survivors than in non- survivors(49.9±23.8 vs 86.3±32.3 P<0.0001). 4) The mean 7th day APACHE III scores was significantly lower in survivors than in non- survivors(30.1±18.5 vs 80.1±30.4, P<0.0001). 5) The odds ratios among the 1st and 7th day APACHE III scores and the mortality rate were 1.0507 and 1.0779 respectively. CONCLUSION: These results suggest that the seventh day APACHE III scores is as useful in predicting the outcome as is such like the first day APACHE III score. Therefore, in comparison to the daily APACHE III score, measuring the 1st and 7th day APACHE III scores are also useful for predicting the prognosis of critically ill patients in terms of cost-effectiveness. It is suggested that the 7th day APACHE III score is useful for predicting the clinical outcome.
APACHE* ; Critical Illness ; Humans ; Intensive Care Units* ; Critical Care* ; Korea ; Length of Stay ; Logistic Models ; Mortality ; Odds Ratio ; Prognosis ; Survivors ; Western World

The purpose of this study was to investigate the effect of 3-month nutrition education (First Time Intervention, FI) + additional 3-month nutrition education (Repeated Intervention, RI) which was performed after the 8-month follow-up. FI was conducted during 0-3 months and RI for 11-14 months. Ninety-two subjects completed FI program, and 38 out of 92 subjects who received FI finished the RI. Anthropometric data, dietary assessment (24hr recall) and fasting blood analysis were measured at 0 month, 3 months, 11 months and 14 months time points. After FI (3 mo), waist circumference, triglycerides, total cholesterol were significantly decreased. At 11 month follow-up, body weight, BMI, hip circumference, SBP, DBP were significantly rebounced and HDL cholesterol was significantly decreased. Therefore, the effect of short-term nutrition education was not being sustained. After the secondary nutrition intervention (14 mo), waist circumference and hip circumference were again significantly decreased. Total diet quality index-international (DQI-I) score was significantly increased in both FI group and RI group. The changes in DQI-I scores were significantly correlated with the changes in body weight (r = -0.129, p < 0.05) and counts of nutrition education (r = 0.159, p < 0.05), indicating that effective nutrition education helps improve the diet quality leading to a possible role in CVD prevention among male workers. Although a short-term intervention seems to be a success, the effect was not retained in this study. Therefore, we suggest incorporating nutrition education as a routine program for male worker at worksite.
Body Weight ; Cholesterol ; Cholesterol, HDL ; Diet ; Fasting ; Follow-Up Studies ; Hip ; Humans ; Male ; Triglycerides ; Waist Circumference ; Workplace

OBJECTIVE: To evaluate the effectiveness of the modified constraint-induced movement therapy (CIMT) for inpatient rehabilitation of the stroke patients. METHOD: Twenty-four patients admitted by subacute or chronic stroke were enrolled and divided into two groups, experimental and control groups. The experimental group (n=13) received the CIMT five days a week for 2 weeks. Less affected arm was restrained for 14 hours a day, practicing purposeful activities with more affected arm for 6 hours a day in group setting. The control group (n=11) received conventional occupational therapy for the same period. The outcome was measured by Fugl-Meyer MotorAssessment (FMA), Brunnstrom stage, Jebsen hand function test, grip strength, Box and Block test, nine hole peg test, Functional Independence Measure (FIM), and Motor Activity Log (MAL). RESULTS: The experimental group showed significantly higher improvements (p<0.05) in FMA, Brunnstorm stage, Jebsen hand function test, grip strength, Box and Block test, FIM, and MAL. CONCLUSION: Modified CIMT delivered in group setting is considered to be an effective treatment to improve functional use of the hemiparetic arm of stroke patients in inpatient setting.
Arm ; Hand ; Hand Strength ; Humans ; Inpatients* ; Motor Activity ; Occupational Therapy ; Paresis ; Rehabilitation ; Stroke*

Ganglioneuromas are neuroectodermal tumors composed of varying amount of ganglion cells, nerve fibers, supporting cells of the enteric nervous system. Ganglioneuromas of the GI tract are rare tumors. A 50-year-old man came to our hospital due to the mass of liver and adrenal gland which was examined with ultrasonography at local medical center. On admission, abdominal magnetic resonance imaging was taken and liver biopsy was done. The mass of liver was hyperplastic nodule. At colonoscopy, about 0.3~0.8 cm sized six polyps were noted. Except the 0.6 cm sized semipedunculated polyp of the ascending colon, the others were tubular adenomas. Histological examination of the polyp of the ascending colon revealed localized proliferation of nerve fibers and ganglion cells. These cells are positive for S-100 protein by immunihistochemistry. Therefore, he was diagnosed with polypoid ganglioneuroma of the ascending colon. We report this case because the solitary ganglioneuroma in large intestine without systemic disease was rare.
Adenoma ; Adrenal Glands ; Biopsy ; Colon, Ascending ; Colonoscopy ; Enteric Nervous System ; Ganglion Cysts ; Ganglioneuroma ; Gastrointestinal Tract ; Humans ; Intestine, Large ; Liver ; Magnetic Resonance Imaging ; Middle Aged ; Nerve Fibers ; Neuroectodermal Tumors ; Neurons ; Polyps ; Porphyrins ; S100 Proteins

BACKGROUND/AIMS: Tetanus is a fatal disease and various complications affect its prognosis. In Korea, tetanus cases have been reported, but no studies, thus far, have examined its complications. We investigated the complications of tetanus and analyzed the risk factors for nosocomial pneumonia, one of most common complications of tetanus. METHODS: We retrospectively reviewed the clinical features, treatment, and complications of 42 patients diagnosed with tetanus at Chonnam National University Hospital from January 1999 through June 2008. The severity of tetanus was assessed using the APACHE II and Ablett scores. We compared two groups, one with nosocomial pneumonia and the other without it, and analyzed the risk factors for nosocomial pneumonia. RESULTS: Forty-two patients (13 men, 29 women) were enrolled. Only three of them had received a primary tetanus vaccination; the others had not received primary or booster vaccinations. Twenty-one patients needed mechanical ventilation. The most common infectious complication was pneumonia (47.4%), followed by blood stream (15.8%) and urinary tract (13.2%) infections. Regarding noninfectious complications, dysautonomia was also common, including fluctuating blood pressure (31.6%), arrhythmias (26.3%), and cardiac arrest (7.9%). Nosocomial pneumonia was associated with autonomic disturbance (OR=32.0, 95% CI 1.9-524.2; p=0.005) and length of stay in the intensive care unit (OR=1.145, 95% CI 1.02-1.29; p=0.024) in the multivariate analysis. CONCLUSIONS:Careful monitoring and treatment of complications are essential in managing tetanus, along with specific therapy for tetanus itself. Education and tetanus immunization are important for preventing the disease, especially in high-risk areas.
APACHE ; Arrhythmias, Cardiac ; Blood Pressure ; Heart Arrest ; Humans ; Immunization ; Incidence ; Intensive Care Units ; Korea ; Length of Stay ; Male ; Multivariate Analysis ; Pneumonia ; Primary Dysautonomias ; Prognosis ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Rivers ; Tetanus ; Urinary Tract ; Vaccination

No abstract available.
Adult ; Asian Continental Ancestry Group ; Base Sequence ; Brachydactyly/diagnosis/*genetics ; DNA/chemistry/genetics/metabolism ; DNA Mutational Analysis ; Fingers/abnormalities ; Hedgehog Proteins/*genetics ; Humans ; Male ; Pedigree ; Polymorphism, Single Nucleotide ; Republic of Korea ; Toes/abnormalities

PURPOSE: Purpose of this study was to identify major trends of action research from 2006 to 2013 and suggest directions for activating and advancing domestic action research in nursing. METHODS: A review was made of 118 action research studies in hospital settings reported in international journals. Search from PubMed, Ovid, and CINHAL was done using analysis criteria developed by the researchers. General and methodological characteristics and focus on changing outcomes of action research were analyzed. RESULTS: The major group of researchers belonged to colleges/universities (40.7%). Methods included use of qualitative methods (61.0%), research questions (24.6%), and use of theoretical models (35.6%). Prevalent data collection methods were interviews (20.2%), and 48.3% showed more than a 1-cycle process including spiral circulation structure. Focus of changing outcomes of the 56 papers including more than 1-cycle were practice (66.1%), environment (8.9%), client-nurse (7.1%). CONCLUSION: Trends in action research in nursing were identified providing necessary reasons to increase action research in nursing as follows: needs of various researchers including stakeholders as well as healthcare providers, various research designs including unconstrained reflection and writing, specific presentation of adapted theoretical models and action strategies, and quality assurance for validity and reliability of research processes and outcomes.
Data Collection ; Health Personnel ; Health Services Research* ; Humans ; Models, Theoretical ; Nursing* ; Reproducibility of Results ; Research Design ; Writing

The rates and severity of Clostridium difficile infections, including pseudomembranous colitis, have increased markedly. However, there are few effective treatments for refractory or recurrent C. difficile infections and the outcomes are poor. Fecal microbiota transplantation is becoming increasingly accepted as an effective and safe intervention in patients with recurrent disease, likely due to the restoration of a disrupted microbiome. Cure rates of >90% are being consistently reported from multiple centers. We cured a case of severe refractory C. difficile infection with fecal microbiota transplantation in a patient colonized by vancomycin-resistant enterococcus.
Clostridium difficile* ; Colon* ; Enterococcus* ; Enterocolitis, Pseudomembranous ; Humans ; Microbiota*

PURPOSE: Interleukin (IL) -13 plays a pivotal role in the induction of immunoglobulin E (IgE) and in the pathogenesis of atopic dermatitis (AD). Recently, an association was reported between the polymorphism of the IL-13 promoter region (-1512A/C) and atopic asthma. We investigated the association between the IL-13 single nucleotide polymorphism (SNP) in the promoter region (-1512A/C) and atopic dermatitis in Korean children with AD. METHODS: We enrolled 204 allergic AD, 92 non-allergic AD, and 116 non-atopic healthy children. Evaluated phenotypes of atopic dermatitis included total IgE, total eosinophil count, and eosinophil fraction. We used a PCR-RFLP method to identify IL-13 genotypes. RESULTS: The allele frequencies of the IL-13 promoter polymorphism (-1512A/C) did not differ statistically among the three groups. Children with one or two copies of risk alleles in the promoter region (-1512C) did not show any significant association with the clinical phenotypes of atopic dermatitis including total IgE, eosinophil phenotypes and SCORAD score in the allergic or non-allergic atopic dermatitis. CONCLUSION: These data suggest that the -1512A/C polymorphism of IL-13 gene may not be associated with neither the development nor the clinical phenotypes of atopic dermatitis in Korean children.
Alleles ; Asthma ; Child* ; Dermatitis, Atopic* ; Eosinophils ; Gene Frequency ; Genotype ; Humans ; Immunoglobulin E ; Immunoglobulins ; Interleukin-13* ; Interleukins ; Phenotype ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic