Because the oral mucositis is often inevitable in acute leukemia patients during chemotherapy, the efforts must be made to keep these leuekmia patients from oral mucositis. So we tried to develop two oral care protocols for reducing the level of oral mucositis during cytotoxic therapy through literature review and our clinical experience. This quasi-experimental study was performed to compare the prohpylatic value of these oral care protocols. Thirty-seven subjects were assigned to one of three groups. The first group performed bivon-normal saline gargling protocol, the second group performed chlorhexidine gargling protocol, and the last contrast group kept traditional gargling protocol, The Oral Assessment Guide(OAG), the Beck's perception of oral comfort, and the discomfort of oral gargling solution were used to assess oral status and subject's oral discomfort during chemotherapy. Each subjects were observed daily from the start of the chemotherapy until Absolute Nertrophil Count (ANC) reached 1,000/mm3. It continued about 2-4 weeks. The data were analyzed by ANCOVA and Kruskal-Wallis oneway ANOVA. The results were as follows : The control group showed significantly highest mean score of the OAG and Beck's perception of oral discomfort among three groups. However the mean score of OAG and Beck's perception of oral discomfort were not significantly different, the bivon saline group showed significantly lowest mean scores among three groups. In conclusion, we recommend that nurses who care acute leukemia patients use bivon-normal saline gargling protocol to reduce the level of oral mucositis during chemotherapy.
Chlorhexidine* ; Drug Therapy* ; Humans ; Leukemia* ; Stomatitis*

PURPOSE: The purpose of this study was to compare contrast dacryocystography with lacrimal dacryo-scintigraphy in correlation with epiphora, superiority in localization of the site of obstruction and discomfort of partient during procedures. MATERIAL AND METHODS: Lacrimal dacryoscintigraphy and contrast dacryocystography were performed in 200 lacrimal drainage systems in 100 patients who were referred to our hospital with epiphora since January, 1993. RESULTS: Lacrimal dacryoscintigraphy showed 88% in correlation with epiphora, 90% in positive predictive value and 74% in negative predictive value. Contrast dacryocystography showed 72% in correlation with epiphora, 97% in positive predictive value and 60% in negative predictive value. Contrast dacryocystography was superior to lacrimal dacryoscintigraphy in localization of the site of the obstruction because of limitation of resolution of 6mm pin hole collimator. But discomfort of patient was variable and severe on contrast dacryocystography. CONCLUSION: When obstruction is suspected, we recommend the lacrimal dacryoscintigraphy as initial radio-graphic study. If adequate information is not available and confirmation is necessary, contrast dacryo-cystography should be done in next step. Inspite of patient symptom, if finding of contrast dacryocystography is normal, lacrimal dacryoscintigraphy should be performed to exclude functional obstruction.
Drainage ; Humans ; Lacrimal Apparatus Diseases*

PURPOSE: The purpose of this study was to compare contrast dacryocystography with lacrimal dacryo-scintigraphy in correlation with epiphora, superiority in localization of the site of obstruction and discomfort of partient during procedures. MATERIAL AND METHODS: Lacrimal dacryoscintigraphy and contrast dacryocystography were performed in 200 lacrimal drainage systems in 100 patients who were referred to our hospital with epiphora since January, 1993. RESULTS: Lacrimal dacryoscintigraphy showed 88% in correlation with epiphora, 90% in positive predictive value and 74% in negative predictive value. Contrast dacryocystography showed 72% in correlation with epiphora, 97% in positive predictive value and 60% in negative predictive value. Contrast dacryocystography was superior to lacrimal dacryoscintigraphy in localization of the site of the obstruction because of limitation of resolution of 6mm pin hole collimator. But discomfort of patient was variable and severe on contrast dacryocystography. CONCLUSION: When obstruction is suspected, we recommend the lacrimal dacryoscintigraphy as initial radio-graphic study. If adequate information is not available and confirmation is necessary, contrast dacryo-cystography should be done in next step. Inspite of patient symptom, if finding of contrast dacryocystography is normal, lacrimal dacryoscintigraphy should be performed to exclude functional obstruction.
Drainage ; Humans ; Lacrimal Apparatus Diseases*

PURPOSE: To evaluate the effectiveness and problems of Gianturco stent for treatment of esophagorespiratory fistulas caused by esophageal carcinoma. MATERIALS AND METHODS: In a 6~year period, we have treated 95 patients of esophageal carcinomas with silicone-covered modified Gianturco stent. Among those patients, ten had an esophagorespiratory fistula. We retrospectively analyzed the effect of stent for the occlusion of esophagorespiratory fistula, food intake capacity of patients, clinical and procedural problems of the stent. RESULT: After procedure, all fistulas were occluded successfully. Of the 10 patients, two could swallow all kinds of food, four most of foods, three soft foods, and one only liquid foods. In one patient, the fistula was reopened probably resulting from the reflux due to the presence of another lesion in the distal esophagus at 1 week after procedure. Two patients complained of dyspnea due to tracheal compression by the proximal tip of the stent and tracheal invasion of tumor after 4 and 11 weeks. In one patient, fistula was recurred due to tumor overgrowth on proximal and distal portion after 24 weeks. The fistulas recurred from the tumor overgrowth or reflux were sucessfully treated with another esophageal stent. The tracheal compression by the proximal tip of the stent and invasion by esophageal cancer was treated with tracheal stent and radiation therapy. CONCLUSION: Insertion of silicone-covered modified Gianturco stent was an effective method for the palliative treatment of esophagorespiratory fistula caused by esophageal cancer. Simultaneous use of tracheal stent is also recommended in patients with tracheal compression by the proximal tip of the stent and invasion by esophageal cancer.
Dyspnea ; Eating ; Esophageal Neoplasms ; Esophagus ; Fistula* ; Humans ; Palliative Care ; Retrospective Studies ; Stents*

PURPOSE: To assess the efficiency of a fluoroscopy-guided double balloon technique in removal of esophageal foreign bodies. MATERIALS AND METHODS: Seven patients with esophageal foreign bodies were treated by fluoroscopy-guided double balloon technique. They suffered from dysphagia. Foreign bodies were meats(n=3), a pig bone, a beef bone, a tablet, and a chinese cabbage leaf. Three patients had underlying diseases:corrosive stricture (n=2) and postoperative stricture(n=1). Double balloon technique for removal of the foreign bodies was performed by trapping a foreign body with two valvuloplasty balloons under fluoroscopic guidance. After removal of a foreign body, stricture sites in three patients were dilated by single balloon. RESULTS: Foreign bodies were removed successfully in all patients with improvement of symptoms. Three patients with stricture were successfully treated by single balloon dilatation. There was no complication with the procedure. CONCLUSIONS: Removal of esophageal foreign bodies with fluoroscopically guided double balloon technique is effective and promising alternative to esophagoscopic removal. In addition, balloon technique is effective in the treatment of underlying esophageal stricture.
Asian Continental Ancestry Group ; Brassica ; Constriction, Pathologic ; Deglutition Disorders ; Dilatation ; Esophageal Stenosis ; Foreign Bodies* ; Humans