BACKGROUND: Epidural adhesion can cause pain from compression and irritation of nerves. But a simple injection into the lumbar epidural space usually goes into the area of least resistance and cannot deliver the medication to the target area. Thus, the adhesiolysis of the affected area is sometimes mandatory. We performed an adhesiolysis, irrigating with normal saline, and targeted an injection of a local anesthetic and steroid mixture to the epidural space, using a flexible catheter-secured epiduroscopic unit in 15 patients with low back pain, and assessed the pain score changes. METHODS: With the patient in the prone position, the epidural space was entered with a 17-gauge Tuohy needle. A guide-wire was inserted through the needle and advanced under fluoroscopic guidance to the level of the suspected pathology. A catheter was then advanced over the guide-wire. After the removal of the guide-wire, an adapter was then attached to the proximal end of the catheter, and its side arm was connected to a syringe containing normal saline flush. The 0.9 mm diameter fiberoptic scope was introduced into the catheter via the adaptor, and a video camera was then attached. Gentle irrigation of normal saline less than 50 ml distended the epidural space. The catheter and fiberoptic scope were advanced to the adhesion area and adhesiolysis was done by moving the tip of the steering catheter. Assuming that original NRS (Numeric Rating Scale) before the procedure was 10, we asked the NRS at 1, 4, 8, 12, 16 weeks after the epiduroscope. RESULTS: NRS at 1, 4, 8, 12, 16 weeks after the epiduroscope showed significant decrease of both low back pain and radiating pain, compared with the original pain (P<0.05). CONCLUSIONS: The flexible catheter-secured epiduroscopic unit proved to be painless, safe, and more simple, than an operation, it is, thus, a practical method for pain relief using adhesiolysis and irrigation of epidural space under the direct visualization of the epidural space in patients with low back and lower extremity pain.
Arm ; Catheters ; Epidural Space ; Humans ; Low Back Pain ; Lower Extremity* ; Needles ; Pathology ; Prone Position ; Syringes

BACKGROUND: Histamine, released from mast cells in atheromatous plaque, has been known to cause cardiac ischemia or sudden cardiac death in atherosclerosis patient. Previous reports have suggested that histamine induced coronary vasoconstriction was due to increase in IP(3) and DAG, which induce release of Ca2+ from SR and increase the Ca2+ sensitivity of contractile element via activation of PKC. Recently, it was reported that application of histamine cause depolarization of intestinal smooth muscle, which may contribute to histamine-induced contraction via augmenting Ca2+ influx through activation of Ca2+ channels. However, the underyling mechanism of histamine-induced depolarization and its contribution to the magnitude of coronary vasoconstriction are still uncertain. METHOD: To elucidate the underlying mechanism of Ca2+ influx change during histamine-induced vasoconstriction, we examined the effect of Ca2+ channel antagonist and PKC blocker on histamine-induced contractions, and then measured the effect of PKC antagonist on whole cell K+ current using patch clamping method in rabbit coronary smooth muscle cells. RESULTS: Application of histamine induced phasic and tonic constraction of coronary rings via activation of H(1) receptors. Pretreatment of Ca2+ channel antagonist (nifedipine, 1 microM) or PKC blockers (10 nM staurosporine and 10 microM Go6976) markedly inhibited histamine-induced tonic contraction, which suggest that the magnitude of tonic contraction depend on the Ca2+ influx. Application of 4-AP, a blocker of voltage-dependent K+ channels, increased resting tone of coronary rings, and combined treatment of nifedipine blocked this 4-AP induced increase of resting tone. Application of active analoge of DAG (1,2-DiC(8)) significantly inhibited the activity of voltage-dependent K+ current in single smooth muscle cell, meanwhile the inactive analogue of DAG (1,3-DiC(8)) has no apparent effect on the activity of voltage-dependent K+ current. Furthermore, pretreatment of calphostin C (1 microM), a blocker of PKC, diminished the 1,2-DiC(8)-induced inhibition of K+ current. CONCLUSION: PKC dependent inhibition of voltage-dependent K+ current may be responsible for the maintaining of histamine-induced tonic contraction in rabbit coronary artery.
Atherosclerosis ; Constriction ; Coronary Vessels* ; Death, Sudden, Cardiac ; Histamine ; Humans ; Ischemia ; Mast Cells ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Nifedipine ; Protein Kinase C ; Staurosporine ; Vasoconstriction

PURPOSE: The quasi-experimental study was conducted to investigate the effects of the integrated NICU hospitalization education on maternal attachment, maternal self-esteem, and EPDS in the 26 mothers of high-risk infants(HRI). METHOD: The subjects were divided into the experimental group to received the integrated NICU hospitalization education included the enforced direct education of NICU and HRI to the mothers using a booklet and the provision of the neomaternal exposure as soon as possible after delivery. The control group received the routine education of the NICU hospitalization, mostly including the admission process and the NICU rules delivering to the husband. The research variables were maternal attachment, maternal self-esteem, and EPDS. RESULTS: The results showed the increases in these variables after the integrated education in experimental group compared to the control group. CONCLUSION: It supports the benefits of the early direct NICU education and the neomaternal exposures on maternal adaptation process in the mothers of HRI.
Depression, Postpartum* ; Education* ; Female ; Hospitalization* ; Humans ; Infant* ; Mothers* ; Pamphlets ; Postpartum Period* ; Spouses ; Child Health

PURPOSE: The study was done to explore growth variation in head circumference (HC) in extremely premature infants (EPI) with brain injury. METHODS: A retrospective cohort study was conducted with 79 cohort samples from the archives of the catch-up growth project. Mean age of the infants was 29.2 weeks of gestation and mean HC, 27.1 cm at birth. Their HC measurements were retrieved from the archives up to 6 month of corrected age (CA) and analyzed against history of brain injury during hospitalization. RESULTS: Overall growth retardation in HC was observed in the cohort sample compared to longer gestation premature infants. EPI with brain injury showed decreased HC compared to infants without brain injury, and resulting growth variation across 6 month of CA. Highest retardation in HC growth was observed in male infants with brain injury. CONCLUSION: Extreme preterm birth itself may function as a major obstacle against HC growth toward term age in EPI. Sustainability of brain injury could be observed with higher HC growth retardation after term. Evolutionary favor to female infants may exist in HC growth of EPI. Intensive education on HC monitoring is highly suggested for parents of EPI, particularly with children with brain injury.
Brain ; Brain Injuries ; Child ; Cohort Studies ; Female ; Gestational Age ; Head ; Humans ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Premature ; Male ; Parents ; Parturition ; Pregnancy ; Premature Birth ; Retrospective Studies ; Child Health

PURPOSE: This was a cross sectional descriptive study to introduce the Infants Coma Scale (ICS), describe mental status of high risk infants using ICS and explore the relationships between ICS and clinical variables in infants hospitalized in a neonatal intensive care unit of a university hospital in Korea. METHODS: After ICS was developed and tested by the authors, a research nurse evaluated the mental status of the infants using the English version of ICS and obtained clinical information on the infants from their medical records. RESULTS: Data from 88 infants were analyzed. About 60% were male, 90% were preterm births, and 40% had pathologic abnormalities. Their mean gestational age was 32.4 (+/-3.50) weeks and the mean birth weight was 1,842 (+/-728.6) grams. The Cronbach's alpha for the ICS was .78. There was a statistically significant positive correlation between ICS total score and five clinical variables including gestational age, birth weight, 1 and 5 min Apgar scores and respiration status. CONCLUSION: Mental status is an important parameter in nursing assessment. ICS is a valid and reliable instrument, which clinicians can easily use to evaluate the mental status of high risk infants.
Birth Weight ; Brain Injuries/diagnosis/ultrasonography ; Female ; Gestational Age ; *Glasgow Coma Scale ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Neonatal ; Male ; *Mental Health ; Premature Birth ; Program Evaluation ; Respiration, Artificial

PURPOSE: Knowing the accurate GA is critical in nursing care of high-risk newborns. A descriptive study was performed to examine the reliability and clinical applicability of the new Ballard examination (NBE) in high-risk infants. METHOD: A NBE was performed to measure GA by assessing the neuromuscular and physical maturity in the course of physical examination of a convenient sample of 50 high-risk infants. RESULTS: 1) There was a highly correlation between both the GA by LMP (GA-LMP) and GA by NBE (GA-NBE) (r = .894, p = .000) 2) There was a greater positive relationship in neuromuscular maturity than physical maturity in the GA-NBE of the high-risk newborn (r = .657 versus r = .915, p<. 05). 3) The high-risk infants were thoes with congenital anomalies, prematurity, and RDS(Respiratory Distress Syndrome). Male infants showed a higher neuromuscular maturity, compared to female infants. 4) There was a positive correlation between neuromuscular, physical, total maturity, GA-LMP and GA-NBE in the birth weight, 1 minute Apgar score. CONCLUSION: The study supports the reliability an clinical relevance of NBE in assessment of the accurate GA in high-risk infants.
Apgar Score ; Birth Weight ; Female ; Gestational Age* ; Humans ; Infant* ; Infant, Newborn ; Male ; Nursing Care ; Physical Examination

The incidence of traumatic brain injury (TBI) has increased with the advanced technology of society. A careful evaluation of associated problems, initial severity, and complications is important for the acute management and rehabilitation of patients with TBI. To predict the rehabilitation potentials of patients with TBI, we have retrospectively investigated the causes, types of injury, associated problems, and complications in 186 patients and also assessed the rehabilitation outcomes by measuring the functional gains according to the types of brain injury and the initial severities evaluated by the Glasgow coma scale in 82 patients. The functional gains were measured by differences of the Mini-mental status examination, PULSES profile, and Barthel index of pre- and post-rehabilitation states. The incidence of TBI was highest in the 3rd decade men and the most common cause was a traffic accident (120 cases, 64.5%). The types of brain injury were a diffuse axonal injury, 87 cases (46.8%); epidural hematoma, 21 cases (11.3 %); subarachnoid hemorrhage, 25 cases (13.4%); subdural hematoma, 28 cases (15.1%); and intracerebral hematoma, 25 cases (12.9%). Common associated problems were fractures and injuries of nervous system. The 7th cranial nerve and the peroneal nerve were the most common injuries for cranial and peripheral nerves, respectively. Common complications were pulmonary and skin disorders. Total hospital stay and the duration for rehabilitation were not significantly different by the types of injury. Functional gain tended to be higher in the intracerebral hematoma compared to the other types of brain injury. The functional gain was statistically higher in patients with initial severity of moderate degree according to the Glasgow coma scale. In conclusion the moderate traumatic brain injured patients seem to have a higher potential for the good functional outcome.
Accidents, Traffic ; Brain ; Brain Injuries* ; Cranial Nerves ; Diffuse Axonal Injury ; Glasgow Coma Scale ; Hematoma ; Hematoma, Subdural ; Humans ; Incidence ; Length of Stay ; Male ; Nervous System ; Peripheral Nerves ; Peroneal Nerve ; Rehabilitation* ; Retrospective Studies ; Skin ; Subarachnoid Hemorrhage ; Treatment Outcome*

No abstract available.
Headache ; Injections, Epidural ; Pneumocephalus

OBJECT: It is to evaluate the priority area for effective eye care service to the aged population of rural comniunity at present and in future. METHOD: Number of aged group surveyed on 60 and over 60 years age that, counted 531 among the total 580 patients. Visual acuity was tested and refractive error was measured by Retinornax (Nikon, Japan) . Ocular examination was performed to determine the causes of visual impairment. This survey was conducted under the auspices of the Korean Foundation for Prevention of Blindness with assistance of the Seoul National University Postgraduate School of Public Health from 1994 to 1996 at the Public Health Center of Chun-Cheon, Kang-Won Do(Province). RESULTS: Age distribution showed the sixties (60-69) 49,3%, the seventies (70-79) 33.9%, and the eighties (80) 16.8%. Proportion of visual acuity of 0.7 or upper in the better eyes constituted 32.2% and of 0.2 or worse 19.4%. Causes of visual impairnnente consisted of refractive errors 35. 9%, cataract 35. 9%, macular degeneration 7, 4%, and corneal opacity 3.9% in order. Contributed modes of care were spectacles 27.9%, surgeries 23.9% (cataract, operation, pterygium removal etc.), and medical treatment 23.9%. DISCUSSION: Surgery of the aged population in rural comrnunity of Chun-Cheon revealed the most. prevalent. causes of visual impairment as the refractive errors and cataract. It is suggested that. the most effective eye care would be provided systemically based 0 the result of the epidemiological study on the various ocular disorders.
Age Distribution ; Blindness ; Cataract ; Corneal Opacity ; Epidemiologic Studies* ; Eyeglasses ; Gangwon-do ; Humans ; Macular Degeneration ; Pterygium ; Public Health ; Refractive Errors ; Seoul ; Vision Disorders ; Visual Acuity

BACKGROUND: Healthcare-associated infections (HAIs) are among the most important threats to patient safety. When hospitalized children face these threats, there is morbidity, mortality, prolonged hospitalization, and increased healthcare costs. Research on local healthcare epidemiology is necessary to enhance collective knowledge and evidence formanaging this problem. METHODS: We performed a retrospective analysis of databases of patients who were diagnosed with HAIs at Chung-Ang University Hospital (CAUH) from 2007 through 2011. Cases were selected from the microbiology registry databases. The data on prevalence of HAIs in various wards and its annual trends were compared to previously reported nationwide data. Moreover, we analyzed the patterns of antibiotic susceptibility results for HAI pathogens. RESULTS: A total of 181 HAIs were identified in 122 patients. The HAI rate among pediatric patients at CAUH was 2.4/1,000 person-hospital days. Urinary tract infections (UTIs) (53 episodes, 29.3%) were the most common, followed by pneumonia (33 episodes, 18.2%). Staphylococcus aureus was found to be the most common gram-positive organism, whereas Escherichia coli was the most common gram-negative organism. Methicillin-resistant S. aureus (MRSA) comprised 84% of the S. aureus infections. Imipenem resistance was detected in 58.8% and 55.0% of Acinetobacter baumannii and Pseudomonas aeruginosa isolates, respectively. CONCLUSION: Between 2007 and 2011, UTIs were the most common type of HAIs, and MRSA was the most common pediatric HAI pathogen, both in the general ward and intensive care unit at the CAUH. Further research on the epidemiology and pathogenesis of HAIs is necessary and prevention measures should be implemented to prevent HAIs in children.
Acinetobacter baumannii ; Child ; Child, Hospitalized ; Delivery of Health Care ; Escherichia coli ; Health Care Costs ; Hospitalization ; Humans ; Imipenem ; Intensive Care Units ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Patient Safety ; Patients' Rooms ; Pneumonia ; Prevalence ; Pseudomonas aeruginosa ; Retrospective Studies ; Staphylococcus aureus ; Urinary Tract Infections