PURPOSE: We evaluated the distribution of hypoperfusion in patients with traumatic brain injury (TBI) and the relationship of thalamic hypoperfusion to severity of cognitive and behavioral sequelae. MATERIALS AND METHODS: Tc-99m ECD SPECT and MRI were performed in 103 patients (M/F=81/22, mean age 34.7+/-15.4 yrs) from 0.5 to 55 months (mean 10.3 months) after TBI. The patients were divided into three groups showing no abnormalities (G1), focal (G2) and diffuse injury (G3) on MRI. Psychometric tests assessed 11 cognitive or behavioral items. In all patients, we evaluated the distribution of hypoperfused areas in SPECT, and in 57/103 patients, neuropsychological (NP) abnormalities in patients with thalamic hypoperfusion were compared with those of patients without thalamic hypoperfusion. RESULTS: The perfusion deficits were most frequently located in the frontal lobe (G1, 42.3%: G2 34.5%: G3 33.3%), temporal lobe (24~26%) thalami (21~22.4%), parietal and occipital lobe (< or =10%). Numbers of NP abnormalities in the cases of cortical hypoperfusion with or without concomitant thalamic hypoperfusion were following: the former 4.7+/-1.5 and the latter 3.2+/-1.4 in G1, 5.0+/-1.1 and 4.8+/-1.2 in G2, 6.8+/-1.8 and 6.3+/-1.1 in G3, respectively. This difference according to thalamic hypoperfusion was significant in G1 (p=0.002), but was not significant in G2 or G3. CONCLUSION: SPECT in patients with TBI had demonstrated hypoperfusion mostly involving the frontal, temporal and thalami. In normal group on MRI, frontal hypoperfusion was more prominent than that of any other group, Furthermore in this group, SPECT could predict severity of NP outcome by concomitant thalamic hypoperfusion with cerebral cortical abnormalities.
Brain Injuries* ; Brain* ; Equidae* ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Occipital Lobe ; Perfusion ; Psychometrics ; Rabeprazole ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon*

A 63-year-old male who had subtotal gastrectomy for early gastric cancer three months ago underwent Tc-99m bone scintigraphy for the evaluation of skeletal metastases. He had no symptoms such as fever, tenderness, or wound discharge. On physical examination, the surgical scar along the midline of the upper abdomen had keloid formation and there was no radiographic evidence of calcification. Bone scintigraphy (Fig. 1A & 1B) demonstrated an unusual linear increased uptake along the midline of the upper abdomen that corresponded to the skin incision for subtotal gastrectomy. Usually, an incisional scar will not be visualized in Tc-99m methylene diphosphate (MDP) scintigraphy beyond two weeks after surgery.1) Upon reviewing the literature, there were only a few reports where localization of Tc-99m MDP in surgical scars were found two months after surgery.2) It was also reported that a few cases with Tc-99m MDP uptake in the keloid scar developed after surgery. Although there are several potential mechanisms that may explain the uptake of Tc-99m MDP in scar tissue, the primary mechanism in older scars is suggested to be a result of pathological calcification.2) Siddiqui et al3) suggested it could be due to microscopic calcification in small resolving hematomas. However, the primary mechanism in keloid scar is not well-known. We should obtain oblique or lateral views to differentiate the uptake in healing surgical scars from the artifactual uptake.
Abdomen ; Cicatrix ; Fever ; Gastrectomy* ; Hematoma ; Humans ; Keloid* ; Male ; Middle Aged ; Neoplasm Metastasis ; Physical Examination ; Radionuclide Imaging ; Skin ; Stomach Neoplasms ; Technetium Tc 99m Medronate* ; Wounds and Injuries

A 60-year-old male with carcinoma of the prostate and cerebral infarction underwent a Tc-99m MDP bone scintigraphy for the evaluation of skeletal metastases. Bone scintigraphy (Fig. 1) showed multiple areas of increased uptake of Tc-99m MDP in the skull, spine, and ribs representing skeletal metastases. Two different patterns of uptake occurred in the skull region (Fig. 1A-C); one represents bony metastasis and the other represents cerebral infarction. The shape, size, location, intensity, and border of the increased uptake differed between the two lesions. An oval-shaped pattern with smaller size, greater intensity and more sharply defined border in the frontal region was consistent with bony metastasis. A rectangular-shaped pattern with larger size, lesser intensity and relatively indistinct border in the temporo-parieto-occipital region was consistent with cerebral infarction. Increased uptake of bone-seeking radiotracers in cerebral infarction has been reported previously.1-4) A suggested mechanism by which bone-seeking radiotracers accumulate in the necrotizing cerebral tissue is an alteration of the blood-brain barrier induced during cerebral infarction, which results in entry of the radiotracers into the extracellular space of the brain.4) Brain CT (Fig. 2) performed 7 days before and one month after the bone scintigraphy revealed lesions on the right temporo-parieto-occipital region consistent with acute hemorrhagic and chronic cerebral infarction, respectively.
Blood-Brain Barrier ; Brain ; Cerebral Infarction* ; Extracellular Space ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis* ; Prostate ; Radionuclide Imaging* ; Ribs ; Skull ; Spine ; Technetium Tc 99m Medronate*

PURPOSE: To evaluate the relation of the location and cell type of lung cancer to the location and degree in coexistent emphysema on high-resolution computed tomography (HRCT) scans. MATERIALS AND METHODS: Ninety-eight of 209 lung cancer patients having HRCT scans were retrospectively analyzed to assess the total lung emphysema and peritumoral regional emphysema. Single and primary lung cancers were included. The clinical data, including sex, age, smoking history and the pathologic cancer subtype, were recorded to correlate with the HRCT findings. The lobar distribution, central-peripheral predominance, surrounding parenchymal abnormality for cancer, cephalocaudal predominance, and subtype for emphysema were analyzed on HRCT. Using a CT scoring method, we scored the whole lung emphysema and peritumoral emphysema, and correlated the grading of emphysema with pulmonary functional values. RESULTS: Sixty-nine of 98 patients with lung cancer (71%) had emphysema. Lung cancer with emphysema was significantly higher in men than in women, and was significantly related to smoking. The mean age of cancer patients without emphysema was significantly lower than that of cancer patients with emphysema (68 yrs vs. 61 yrs, p=0.0006). Emphysema of grade I (0-25%) was found in 52 cases, grade II (25-50%) in 15, and grade III (50-75%) in 2. Total emphysema score was paralleled to peritumoral emphysema score in 64.3%, while the remaining patients had a higher peritumoral emphysema score (grade II or III) than total emphysema score (grade 0 or I). There was no statistical correlation in the developmental location between the emphysema and the lung cancer (significant correlation was only noted in grade II group of total emphysema score). The incidence of non-small cell carcinoma tended to be higher than that of small cell carcinoma in the two groups. CONCLUSION: The possibility of lung cancer in patients with pulmonary nodule, coexisting emphysema, and especially in elderly patients having a history of smoking must be clarified on HRCT. The location or type of lung cancer was not significantly correlated to the location or the degree of coexistent emphysema.
Aged ; Carcinoma, Small Cell ; Emphysema* ; Female ; Humans ; Incidence ; Lung Neoplasms* ; Lung* ; Male ; Pulmonary Emphysema ; Research Design ; Retrospective Studies ; Smoke ; Smoking

OBJECTIVES: The objective of this study was to evaluate the thermic effects, the macronutrient oxidation rates and the satiety of medium-chain triglycerides (MCT). METHODS: The thermic effects of two meals containing MCT or long-chain triglycerides (LCT) were compared in ten healthy men (mean age 24.4 +/- 2.9 years). Energy content of the meal was 30% of resting metabolic rate of each subject. Metabolic rate and macronutrient oxidation rate were measured before the meals and for 6 hours after the meals by indirect calorimetry. Satiety was estimated by using visual analogue scales (VAS) at 8 times (before the meal and for 6 hours after meal). RESULTS: Total thermic effect of MCT meal (42.8 kcal, 8.0% of energy intake) was significantly higher than that (26.8 kcal, 5.1% of energy intake) of the LCT meal. Mean postprandial oxygen consumption was also significantly different between the two types of meals (MCT meal: 0.29 +/- 0.35 L/min, LCT meal: 0.28 +/- 0.27 L/min). There were no significant differences in total postprandial carbohydrate and fat oxidation rates between the two meals. However, from 30 to 120 minutes after consumption of meals, the fat oxidation rate of MCT meal was significantly higher than that of the LCT meal. Comparison of satiety values (hunger, fullness and appetite) between the two meals showed that MCT meal maintained satiety for a longer time than the LCT meal. CONCLUSIONS: This study showed the possibility that long-term substitution of MCT for LCT would produce weight loss if energy intake remained constant.
Calorimetry, Indirect ; Energy Intake ; Humans ; Male ; Meals ; Oxygen Consumption ; Triglycerides* ; Weight Loss ; Weights and Measures

PURPOSE: The purpose of this study was to investigate the reality, status of clinical nurses' emotional labor and the relationship with physical discomfort, burnout, depression and social support. METHODS: A thousand three hundred sixteen clinical nurses from 42 hospitals nationwide participated in this study. Questionnaires were developed for evaluating the reality and status of emotional labor of clinical nurses after interviewing focus groups and reviewing literatures. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient. RESULTS: Ninety eight percent of nurses had answered having emotional labor and they experienced 82 times per year, 9.6 times during last a month which means they experience it every other day. The one who provoke emotional labor were patients, guardians, physicians, supervisor, and colleagues in sequence. Eighty percent of nurses had intention to leave their jobs after experiencing emotional labor. They were doing more surface acting than deep acting of emotional labor. CONCLUSION: Clinical nurses in Korea experienced excessively high level of emotional labor and delayed responding to clients' requests due to lack of time for caring each patient was revealed as one of the main causes of emotional labor.
Depression ; Focus Groups ; Humans ; Intention ; Korea

PURPOSE: The purpose of this study was to evaluate the clinical usefulness of chest high-resolution computed tomography(HRCT) in patients with chronic coughs or persistent wheezing with normal chest X-ray finding. METHODS: We reviewed the charts, chest X-rays, and HRCT findings of patients with chronic coughs or persistent wheezing of less than 2 years of age. The records were sourced from the Department of Pediatrics, Inha University Hospital covering the period from July, 1999 to June, 2000. Chronic cough was defined as a cough which was prolonged for more than 3 weeks. RESULTS: The sample consisted of 24 patients(male 15 and female 9, mean age 4.7+/-3.8 months old). Among them, 16 patients showed normal findings(66.7%) and 8 patients showed abnormal (33.3%) in simple chest X-rays. Among 16 patients who had the normal chest X-rays, 13 patients showed abnormal chest HRCT findings(81.3%) such as air space consolidation of the dependent portion(62.5%), bronchiolitis obliterans(12.5%), and bronchopulmonary dysplasia(6.3%). CONCLUSION: We suggest that the chest HRCT is a useful diagnostic tool in the evaluation of patients with chronic cough or persistent wheezing with normal chest X-ray, especially below 2 years of age.
Bronchiolitis ; Cough* ; Female ; Humans ; Pediatrics ; Respiratory Sounds ; Thorax*

Cholangiocarcinoma has been associated with various fibrocystic diseases of liver and biliary tract, but cholangiocarcinoma in polycystic liver disease (PLD) was extremely rare. It was reported that the prognosis of cholangiocarcinoma associated PLD was very poor and distant metastases were common. We report a rare case of intrahepatic cholangiocarcinoma associated with PLD in 58- year- old female who presented vague abdominal pain. She had also polycystic kidneys with normal renal function. MRI showed well demonstrated tumor with central scar and a adjacent large cyst in the left lobe of the liver. She underwent extended left lobectomy. On microscopic examination, the tumor was moderately differentiated cholangiocarcinoma having abundant fibrous stroma and necrosis and the adjacent cyst showed focal in situ carcinomatous changes in the lining epithelium.
Abdominal Pain ; Biliary Tract ; Cholangiocarcinoma* ; Cicatrix ; Epithelium ; Female ; Humans ; Liver Diseases* ; Liver* ; Magnetic Resonance Imaging ; Necrosis ; Neoplasm Metastasis ; Polycystic Kidney Diseases ; Prognosis ; Cholangiocarcinoma

Purpose: The purpose of this study is to identify changes in knowledge, self-efficacy and anxiety achieved through the provision of video education on chemotherapy with a portable infusion pump to colorectal cancer patients. Methods: This study is a nonequivalent control group and non-synchronized design as a quasi-experimental study. Participants in this study were colorectal cancer patients who received chemotherapy with a portable infusion pump through an ambulatory care unit. For 48 subjects, the education was divided into printed materials and videos, and knowledge, self-efficacy, and anxiety were measured. Data were analyzed using independent t test, paired t-test, and Wilcoxon’s signed rank test. Results: In the video education group, knowledge (Z=-4.09, p<.001) and self-efficacy (Z=-2.72, p=.012) significantly increased after education, and anxiety significantly decreased after education (Z=2.24, p=.035). However, there was no difference in knowledge (t=0.09, p=.931), self-efficacy (t=1.22, p=.229), and anxiety (t=-1.16, p=.250) between the groups after education. Conclusion To improve the quality of life of cancer patients, it is necessary to promote self-efficacy and reduce anxiety. The results of this study suggest that more diverse educational methods should be attempted to improve knowledge and self-efficacy and reduce anxiety in colorectal cancer patients.

PURPOSE: This study aimed was done to analyze recent trends in nursing research published in the Journal of Korean Academy of Nursing by focusing on the content of nursing interventions and their level of evidence. METHODS: A total of 209 studies published between 2007 and 2008 were reviewed using analysis criteria developed by the researchers. RESULTS: The number of quantitative studies was greater than that of qualitative studies. There was a slight increase in the number of qualitative studies and studies including elderly populations, which reflects the recent population trend in Korea. More randomized controlled trials with a low risk of bias were needed to support more evidence-based nursing practice. Concerning the low rate of ethical consideration, stricter application of research ethics needs to be encouraged. CONCLUSION: The findings of this study suggest the recent trends in nursing research and the direction of nursing research and review in the Journal.
Bibliometrics ; Humans ; Nursing Research/*trends ; *Periodicals as Topic ; Qualitative Research ; Republic of Korea