No abstract available.
Humans ; Twins*

Tracheoesophageal fistula with esophageal stenosis were described by Gibson in 1697, and successful primary surgical repair was accompished in 1941 by Haight, but this anomaly had a very grave prognosia, due to prematurity, combined other congenital anomaly, and [ostoperative pulmonary complication. Recently, early diagnosis, better preoperative and postoperative care, and proper anesthetic management have helped lower the mortality rate. Eighteen infants with esophageal atresia with T.E fistula were admitted to Severance Hospital, and 9 infants among these infants were surgically corrected under general anesthesia from Feb. 1970 to Feb. 1981 at Severance Hospital. This report described the results of anesthetic experience in the management of tracheoesophageal fistula, and the problems of anesthetic management of patients with trachoesophageal fistula were reviewed and discussed.
Infant ; Male ; Female ; Humans ; Mortality

BACKGROUND: The heat shock protein (HSP) 70 families are known to protect cells against the irreversible tissue injury induced by stress and to induce the recovery of cell function during stress. Heat pretreatment was reported to decrease the acute lung injury(ALI) of rats induced by lipopolysaccharide (LPS). However the role of heat shock with LPS co-treatmenton ALI is unclear. The purpose of this study was to investigate the effect of heat treatment, which was given immediately after the beginning of ALI induced by LPS intratracheally administered in rats. METHODS: Either saline (saline group) or LPS was intratracheally instilled without heat treatment (LPS group). In addition, heat was conducted 18 hours prior to the instillation of LPS (pre-treatment group) and conducted immediately after instillation of LPS (co-treatment group). Six hours after the LPS or saline treatment, blood, bronchoalveolar lavage (BAL) fluid and lung tissue samples were obtained. The myeloperoxidase (MPO) activity and the heat shock protein expression in the lung tissue, the differential counts of the polymorphonuclear leukocytes (PMN) in the BAL fluids, and the LDH, protein, IL-1beta, TNF-alpha and IL-10 levels in BAL fluid and serum were measured. RESULTS: 1)The MPO activity, the differential PMN counts in the BAL fluid, BAL fluid and serum cytokines were higher in the LPS, the heat pre-treatment and co-treatment group than those of the saline group (p value <0.05). 2)The MPO activity and the protein level in the BAL fluid from the heat co-treatment group were similar to those of the LPS group. 3) The serum TNF-alpha level of the heat co-treatment group was significantly higher than that of the LPS group (p=0.01) . CONCLUSIONS: Heat shock response administered immediately after a LPS instillation did not attenuate the ALI in this model.
Acute Lung Injury* ; Animals ; Bronchoalveolar Lavage ; Cytokines ; Heat-Shock Proteins ; Heat-Shock Response ; Hot Temperature* ; Humans ; Interleukin-10 ; Lung ; Neutrophils ; Peroxidase ; Rats* ; Shock ; Tumor Necrosis Factor-alpha

This study is based on grounded theory methodology by Strauss & Corbin(1998). Ten hospitalized subjects were interviewed for data collection. In the process of data analysis, 'acceptance' is found to be the causal condition, while 'health professionals' skillfulness', 'ward environment', 'history of hospitalization', and 'general conditions' were identified as context, 'felling of relief' as the core phenomenon, 'self-efficacy', 'support of others', and 'life style' as the intermediate situation, 'passive reaction', 'alternative reaction' and 'active reaction' as the strategy and 'stabilization', 'satisfaction', 'hope' and 'carrying out' as consequences. 'Feeling of relief' is found to go through the three stages of recognition-generation-maintenance after the five different patterns. 1) In case the health professionals are skillful, the ward environment is favorable, the general conditions of the patients improved and as a result the feeling of relief is strong, during the first hospitalization, the self-efficacy of the subjects tends to be strong. They proceed toward the goal set for themselves with a renewed hope and active or alternative reaction toward the feeling of relief. 2) The subjects tend to proceed toward the goal set for themselves with a renewed hope and active and alternative reaction toward the feeling of relief in case health professionals are skillful, the ward environment is favorable the general conditions of the subjects improved, self-efficacy is strong, and lifestyle is autonomous, during the second hospitalization even though support of others is merely superficial. 3) The subjects tend to stabilize, and satisfy themselves with the given situation with passive and alternative reaction to the feeling of relief in case health professionals are skillful and the ward environment is favorable but the general conditions worsened and accordingly the feeling of relief, is weak and life style is dependent during the second hospitalization although the subjects' self-efficacy is strong and support of others is specific. 4) The subjects tend to stabilize and satisfy themselves with the given situation with passive and alternative reaction to the feeling of relief in case health professionals are unskillful the ward environment is unfavorable, the general conditions improved, support of others is specific but life style is dependent and self-efficacy is weak during the first hospitalization. 5) The subjects tend to stabilize and satisfy themselves with the given situation in case health professionals are unskillful the ward environment is unfavorable but the general conditions improved support of others is specific and as a result self-efficacy is strong but life style is dependent.
Surveys and Questionnaires ; Health Occupations ; Hope ; Hospitalization ; Humans ; Life Style ; Statistics as Topic

PURPOSE: The purpose of this study was to compare changes in learning objectives in Fundamentals of Nursing which were established between 2000 and 2004. METHOD: 2000, 2004 learning objectives were analyzed with frequencies and percents. RESULTS: There was an increase in the total number of learning objectives used in 2004(n=534) over 2000(n=527). In 2004 compared to 2000, there was an increase in learning objectives related to nursing process, need of oxygenation, need of nutrition, need of temperature regulation, need of activity and exercise, need of comfort, medication, preoperative care. According to Bloom's taxonomy, learning objectives established in 2004, mainly consisted of three domains, 35.5% for comprehension, 23.6% for synthesis, 20.4% for knowledge. Changes in learning objectives established in 2004 compared to 2000 decreases in the comprehension domain and increases in the synthesis domain. CONCLUSION: The learning objectives established in 2004 showed remarkable change when compared to those established in 2000. But the learning objective domains in Bloom's taxonomy were distributed unevenly. For better learning objectives in Fundamentals of Nursing, constant revision will be needed.
Classification ; Comprehension ; Learning* ; Nursing Process ; Nursing* ; Oxygen ; Preoperative Care

PURPOSE: The purpose of this study was to explore the content related to nosocomial infection control in the course on Fundamentals of Nursing. METHOD: Participants were 49 faculty who were teaching courses in Fundamentals of Nursing in universities and colleges in Korea. The questionnaire was composed of 55 items related to nosocomial infection control. RESULTS: Eighteen items out of 55 items were taught in more than 80% of the universities and colleges. These included principles of infection control, principles and effect of hand washing, method of hand washing, hand scrubs, and donning sterile gown and gloves. CONCLUSION: The most effective interventions for infection control, including asepsis, hand washing, infection control for urinary catheterization, and infection control for IV sites were taught in most universities and colleges. However, the time assigned for teaching these items and the importance placed on practice were not considered sufficient.
Asepsis ; Cross Infection* ; Education* ; Hand ; Hand Disinfection ; Infection Control ; Korea ; Nursing* ; Surveys and Questionnaires ; Urinary Catheterization ; Urinary Catheters

PURPOSE: The decrease in bone mineral density (BMD) is a major complication after kidney transplantation. This was reported to occur preferentially during the first 6 months. However, the treatment and prevention strategies against a decline of BMD are not yet clear. METHODS: The data on the pre-transplant baseline and post-transplant 1 year BMD were archived and retrieved in 125 renal transplant recipients. The post-transplant changes of the BMD were compared by the baseline status of the BMD and the types of anti-osteoporosis treatment either with a vitamin D agent (alfacalcidiol) (n=18) or alendronate (n=21). Anti-osteoporosis treatment began within 30 days after transplantation, with an oral administration of 0.5 mcg/day vitamin D or 70 mg/week alendronate, and maintained until 1 year after transplantation. RESULTS: Regardless the degree of baseline BMD status, each group (the control, vitamin D, or alendronate group) showed a significant and uniform decrease of BMD during the post-transplant 1 year. The mean change in the spine BMD in the control, vitamin D, and alendronate group was -7.1+/-7.5%, -3.3+/-7.4% and -2.6+/-6.5%, respectively. The femur BMD also changed -5.1+/-7.7%, 1.1+/-5.3% and -1.5+/-8.2%, respectively. The degree of BMD decrease in the treatment groups was significantly lower than that in the control (P=0.014 in spine, P=0.003 in femur). When the severely reduced baseline BMD (T-score of spine or femur < or =-1) subgroups were analysed separately, the treatment groups (-3.7+/-6.5% in vitamin D and -1.1+/-6.4% in alendronate group) showed a significantly less decrease in the spine BMD than the control (-8.2+/-6.2%)(P=0.036). The femur BMD also showed a less decrease in the BMD in the treatment group, but this was not statistically significant (P=0.234). There was no significant difference between the vitamin D and alendronate treatment groups. CONCLUSION: After renal transplantation, early administration of vitamin D or alendronate showed some benefit to reduce the post-transplant decrease of BMD in both spine and femur area.
Administration, Oral ; Alendronate* ; Bone Density* ; Femur ; Kidney Transplantation* ; Spine ; Transplantation ; Vitamin D* ; Vitamins*

BACKGROUND: Acute Respiratory failure which is developed after extubation in the weaning process from mechanical ventilation is an important cause of weaning failure. Once it was developed, endotracheal reintubation has been done for respiratory support. Noninvasive Positive Pressure Ventilation (NIPPV) has been used in the management of acute or chronic respiratory failure, as an alternative to endotracheal intubation, using via nasal or facial mask. In this study, we evaluated the usefulness of NIPPV as an alternative method of reintubation in paients who developed acute respiratory failure after extubation. METHOD: We retrospectively analyzed thirty one patients (eighteen males and thirteen females, mean ages 63+/-13.2 years) who were developed acute respiratory failure within forty eight hours after extubation, or were extubated unintentionally at medical intensive care unit(MICU) of Asan Medical Center. NIPPV was applied to the patients. Ventilatory mode of NIPPV, level of ventilatory support and inspiratory oxygen concentration were adjusted according to the patient condition and results of blood gas analysis by the attending doctors at MICU. NIPPV was completely weaned when the patients maintained stable clinical condition under 8 cmH2O of pressure support level. Weaning success was defined as maintenance of stable spontaneous breathing more than forty eight hours after discontinuation of NIPPV. Respiratory rate, heart rate, arterial blood gas analysis, level of pressure support, and level of PEEP were monitored just before extubation, at thirty minutes, six hours, twenty four hours after initiation of NIPPV. They were also measured at just before weaning from NIPPV in success group, and just before reintubation in failure group. RESULTS: 1) NIPPV was successfully applied to thirty-one patients of thirty-two trials and one patient could not tolerated NIPPV longer than thirty minutes. Endotracheal reintubation was successfully obviated in fourteen patients (45%) among them. 2) There was no difference in age, sex, APACHE III score on admission at MICU, duration of intubation, interval from extubation to initiation of NIPPV, baseline heart rate, respiratory rate, arterial blood gas, and PaO2/FiO2 between the success and the failure group. 3) Heart rate and respiration rate were significantly decreased with increase SaO2 after thirty minutes of NIPPV in both groups (p<0.05). Ho wever, in the patients of failure group, heart rate and respiratory rate were increased again with decrease in SaO2 leading to endotracheal reintubation. 4) The success rate of NIPPV treatment was significantly higher in the patients with COPD compared to other diseases (62% vs 39%) (p=0.007). 6) The causes of failure were deterioration of arterial blood gas without aggravation of underlying disease (n=9), aggravation of undelying disease (n=5), mask intolerance (n=2), and retained airway secretion (n=1). CONCLUSION: NIPPV would be a useful therapeutic alternative which can avoid reintubation in patient who developed acute respiratory failure after extubation.
APACHE ; Blood Gas Analysis ; Chungcheongnam-do ; Female ; Heart Rate ; Humans ; Critical Care ; Intubation ; Intubation, Intratracheal ; Male ; Masks ; Oxygen ; Positive-Pressure Respiration* ; Pulmonary Disease, Chronic Obstructive ; Respiration ; Respiration, Artificial ; Respiratory Insufficiency* ; Respiratory Rate ; Retrospective Studies ; Weaning

No abstract availalbe.

BACKGROUND: Diffuse alveolar hemorrhage (DAH) is an uncommon pulmonary disease. It could be occurred by diverse causes with the different response to the treatment. However, the clinical features of DAH have not been well known in Korea. METHODS: Twenty cases identified as DAH between March of 1990 and July of 2000 at a university affiliated hospital were retrospectively reviewed. RESULTS: The median age was 45 yr (range: 18~73 yr) with 11 females. Diagnosis was made by clinical and radiologic findings including hemoptysis, newly developed anemia, and diffuse bilateral lung opacities with the continuous bloody lavage fluid or bloody bronchial aspirate on bronchoscopy. The mean APACHE III score was 50.8 (+/-26.7) points. Hemoptysis prior to admission was observed in 8 (40%) patients. Diffuse crackles were heard on the bilateral lung fields in 18 cases. On chest radiographs, diffuse ground glass appearance and/or confluent air space consolidation with ill defined irregular margin were mainly observed. In patients with DAH the hemoglobin level fell a mean of 2.0 (+/-0.8) g/dL. Fourteen (70%) patients received mechanical ventilation due to the respiratory failure. Six patients (30%) were dead during admission. Among these patients, 4 patients were dead due to refractory respiratory failure with continuous DAH. The bleeding tendency such as disseminated intravascular coagulation or low platelet count was higher in dead patients than the survivors (p=0.018). The survivors of DAH with noninfectious causes showed better responses to immunosuppressive drugs with/without plasmapheresis compared to nonsurvivors (p=0.003). CONCLUSION: DAH was prone to develop acute respiratory failure and needed mechanical ventilation frequently. However, DAH of non-infectious causes showing a good response to the immunosuppresive therapy would have a better prognosis. In addition, DAH would have a worse prognosis in cases of combined bleeding tendency.
Anemia ; APACHE ; Bronchoscopy ; Diagnosis ; Disseminated Intravascular Coagulation ; Female ; Glass ; Hemoptysis ; Hemorrhage* ; Humans ; Korea ; Lung ; Lung Diseases ; Plasmapheresis ; Platelet Count ; Prognosis ; Radiography, Thoracic ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Sounds ; Retrospective Studies* ; Survivors ; Therapeutic Irrigation