Urinary retention is a common complication after abdominal surgery. Urinary retention causes infection and damage to the urinary system, prolonging hospital stays and increasing health care costs in the end. Because medical personnel tend to regard urinary retention as not being a serious problem, it is hard to find any method which decrease the postoperative urinary retention. There are few papers reporting the incidence and the factors which influence the postoperative urinary retention. The purpose of this study is to evaluate the incidence of postoperative urinary retention and to identify the factors which affect the postoperative urinary retention. We retrospectively reviewed 296 patients out of 338, who had been undergone laparotomy under spinal or general endotracheal anesthesia during a three month period from January to March 1998. We reviewed nursing, anesthetic and operative records. Among the 296 patients, male were 189(63.9%) and female were 107(36.1%). Postoperative urinary retention occurred in 71 patients(24%). The incidence rate was higher in female patients than in male (M : F=18% : 35%). Factors that in fluence the incidence of postoperative urinary retention were sex, duration of operation, the amount of fluid given the patient, preoperative history of dysuria, and preoperative insertion of a urinary catheter. Among those factors, preoperative urinary catheter insertion is the most effective preventive measure in lowering the incidence of postoperative urinary retention (Spearman correlation coefficient, r=-.462). Shortening the operation time and sparing the fluid which is infused during operation are important in preventing postoperative urinary retention. Preoperative urinary catheter insertion may be helpful in lowering urinary retention in those patients who have a possibility of postoperative urinary retention.
Anesthesia ; Dysuria ; Female ; Health Care Costs ; Humans ; Incidence ; Laparotomy* ; Length of Stay ; Male ; Nursing ; Retrospective Studies ; Urinary Catheters ; Urinary Retention*

Although there are many peri-operative measures to reduce core temperature loss during operation, rapid drop has been experienced in the first sixty minutes following induction of general anesthesia. Recently, preoperative warming has been emphasized to prevent inadvertant hypothermia during operation. The purpose of this study is to find the effect of preoperative warming on reducing rectal temperature drop in surgical patients. With informed consent, 46 female adult patients, scheduled for total abdominal hysterectomy or salpingo-oophorectomy in the Seoul National University Hospital from September 3, 1996 to September 19, 1996 were divided into two groups. The variables of age and body surface were matched between the two groups as possible. Among them, 24 patients were preparatively covered up to the shoulders with a forced-air warming blanket(WARM TOUCHTM). set between 36-40degrees C for prewarming, and the other 22 patients(control group)were not before the induction of anesthesia. Rectal temperature was measured by mercury thermometer for rectum after admission to the operating room and by rectal probe which was inserted in the rectum just before the induction during the operation. The rectal temperature was monitored and recorded at every fifteen minutes for the first sixty minutes after the induction and each step during the surgery(intubation, surgical draping, peritoneum opening, one hour and the end of the operation) Collected data were analyzed by means of t-test, Repeated Measures Analysis of Variance with PC-SAS. The results of this study are as following. (1) There was no significant difference between the two groups in age, weight, height, room temperature, basal rectal temperature, operation time. (2) Temperature gradient of the rectal temperature in the warming group was less steeper than that in the control roup during the first sixty minutes after general anesthesia. (3) The rectal temperature measured at every fifteen minutes for the first sixty minutes and the end of surgery after the general anesthesia showed the difference between the two groups during surgery. (4) There was no rectal temperature difference during the intubation, however there was significant temperature difference between the two groups from draping to the end of surgery. In conclusion, prewarming of the surgical patient before induction resulted in increased the skin temperature and heat content, which relieved the dangerous core temperature drop which is potential to be provoked within one hour after induction of the surgical patients and kept the rectal temperature higher than that of the control group during surgery. The suggestions from this study shown below : First, further study is needed to find the preventive effect of the core temperature drop in the first sixth minutes after anesthetic induction by preoperative warming for gastrorectal, thoracic surgery patients who man have the core temperature drop during the operation. Second, in other to keep patient normothermia during the surgery, it needs to study whether using pre-and peri-operative warming can prevent hypothermia or not. Finally, the study of the peroperative warming effect on surgical patients' relaxation and thermal discomfort before the operation is needed because most patients in the case group said to have felt thermal comfort ; 'comfortable' and 'good'.
Adult ; Anesthesia ; Anesthesia, General ; Female ; Hot Temperature ; Humans ; Hypothermia ; Hysterectomy ; Informed Consent ; Intubation ; Operating Rooms ; Peritoneum ; Rectum ; Relaxation ; Seoul ; Shoulder ; Skin Temperature ; Thermometers ; Thoracic Surgery

PURPOSE: This study was to examine the effects of 3 domains of continuing education (CE) for healthcare managers. METHODS: A group of 20 healthcare managers, attending 3 levels of CE, were the subjects. The data were collected by structured questionnaires before and after each education. The data were analyzed by Friedman test, Wilcoxon Signed Ranked Test, and Bonferroni correction. RESULTS: After completing CE, there was significant improvement on the scores of knowledge, attitude, and skills. CONCLUSION: This study suggests that CE for healthcare managers is an effective strategy to promote the competency of healthcare managers, who take care of the chronically ill patients.
Chronic Disease ; Delivery of Health Care ; Education, Continuing ; Humans ; Surveys and Questionnaires

BACKGROUND: Acute idiopathic thrombocytopenic purpura(ITP) in children has a low morbidity and mortality, and most of cases are self limited illness. But some of them are not responsive to treatment and finally progress to chronic disease. The purpose of this study is to evaluate the factors which influence the outcome in childhood idiopathic thrombocytopenic purpura. METHOD: From January 1990 to December 1995, patients with ITP who were admitted to the Pediatric department of Pusan National University Hospital were divided into acute and chronic form depending on whether the platelet count had returned to normal(150 x 10(9)/1) by six months after diagnosis. Between two groups, the clinical and laboratory characteristics, response to treatment were compared. RESULT: 1) Out of 55 patients with ITP, 36 cases(65.5%) were acute and 19 cases(34.5%) were chronic ITP. 2) Sex, previous viral infection history, clinical manifestations were not significantly different between two groups, but the chronic ITP was rare in less than 1 year of age. 3) The duration of symptoms over >2 weeks at presentation was strongly predictive of chronic ITP. 4) Most of chronic disease (87.5%) showed platelet counts below 150 x 10(9)/1 at 28 days after diagnosis as compared with acute disease(25.0%). 5) Among 19 cases of chronic disease, 6 cases responded completely to treatment, but 11 cases(57.9%) did not respond to any treatments, 2 cases improved spontaneously. CONCLUSION: A history of symptoms over 2 weeks at presentation and platelet counts below 150 x 10(9)/1 at 28 days after diagnosis were strong predictors of chronic ITP in children.
Busan ; Child ; Chronic Disease ; Diagnosis ; Humans ; Mortality ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic*

OBJECTIVE: To identify the incidence and characteristics of language disorders in patients with traumatic brain injury (TBI), and to understand the differences of language disorder according to the degree and lesion of brain damage and the outcomes after proper language training programs. METHOD: The subjects were 24 adult TBI patients. Seventeen patients with language disorder were examined with language disorder screening test. The characteristics of the language disorders were evaluated according to the degree and lesion site of the brain injury. Prognosis of the language disorders was studied. The tests were performed at the initiation and termination of the language treatment program. RESULTS: The incidence of language disorders was 91.7%. At the initial evaluation, all items showed a low rate of correct response, but at the final evaluation, the statistically significant improvement was noted in all items. There was no difference between moderate and severe brain damages at final evaluation. Focal lesion group revealed higher rate of correct response than diffuse lesion group on comprehension, expression, reading, and calculation at final evaluation. CONCLUSION: The TBI patients showed diffuse language dysfunction on fluency, comprehension, expression, reading, writing, and calculation. But the majority of these patients showed satisfactory recovery, especially the focal brain lesion showed the better outcome. These patients with focal lesion were needed precise language evaluation and more intensive language treatment program.
Adult ; Brain ; Brain Injuries* ; Comprehension ; Glasgow Coma Scale ; Humans ; Incidence ; Language Disorders* ; Language Therapy ; Mass Screening ; Prognosis ; Writing

To elucidate iron utilization patterns of Staphylococcus aureus according to the growth, we checked the residual iron concentration and the production of siderophores at the indicated times while culturing S. aureus ATCC 6538 and 25923 strains in brain heart infusion broth. By using streptonigrin susceptibility test and investigating growth curves in three culture media of which iron concentration is 0.2, 20, 45 uM, respectively, we found out that iron metabolism of 6538 strain was more active than that of 25923 strain. In point of tendency of iron consumption, 6538 strain steeply consumed iron just before the onset of stationary phase, but 25923 strain did gradually iron throughout the growth phase. Nevertheless, total amount of iron consumed by each strain during the growth was almost no difference between the strains. CAS diffusion assay in detecting siderophores showed that siderophore production followed iron consumption. These results suggest that the siderophores play significant role in iron utilization in vitro.
Brain ; Culture Media ; Diffusion ; Heart ; Iron* ; Metabolism ; Siderophores ; Staphylococcus aureus* ; Staphylococcus* ; Streptonigrin

The cellular homeostasis of proteins (proteostasis) and RNA metabolism (ribostasis) are essential for maintaining both the structure and function of the brain. However, aging, cellular stress conditions, and genetic contributions cause disturbances in proteostasis and ribostasis that lead to protein misfolding, insoluble aggregate deposition, and abnormal ribonucleoprotein granule dynamics. In addition to neurons being primarily postmitotic, nondividing cells, they are more susceptible to the persistent accumulation of abnormal aggregates. Indeed, defects associated with the failure to maintain proteostasis and ribostasis are common pathogenic components of age-related neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis. Furthermore, the neuronal deposition of misfolded and aggregated proteins can cause both increased toxicity and impaired physiological function, which lead to neuronal dysfunction and cell death. There is recent evidence that irreversible liquid–liquid phase separation (LLPS) is responsible for the pathogenic aggregate formation of disease-related proteins, including tau, α-synuclein, and RNA-binding proteins, including transactive response DNA-binding protein 43, fused in sarcoma, and heterogeneous nuclear ribonucleoprotein A1. Investigations of LLPS and its control therefore suggest that chaperone/disaggregase, which reverse protein aggregation, are valuable therapeutic targets for effective treatments for neurological diseases. Here we review and discuss recent studies to highlight the importance of understanding the common cell death mechanisms of proteostasis and ribostasis in neurodegenerative diseases.

BACKGROUND: The effective ventricular function during ejection and filling is likely to depend on the coordinated action of the longitudinally and circumferentially orientated myocardial fibers and the function of these longitudinal fibers has not been extensively studied. METHODS: The role of longitudinally and circumferentially orientated fibers in left ventricular wall motion was evaluated by M-mode echocardiograms of the mitral ring(whose motion reflect long axis change) and the standard minor axis(left ventricular posterior wall), simultaneous recordings of phonocardiograms and electrocardiograms on the paper (speed 100mm/sec), in 24 healty individuals, 17 patients with mitral stenosis, 11 patients with open mitral commissurotomy and 17 mitral valve replaced patients. RESULTS: In the controls long axis shortening significantly preceded minor axis shortening (phase difference between two axes : 20+/-3 msec, mean+/-SEM) during early systole, indicating left ventricle become more spherical. This phase difference was also observed in the patients with mitral stenosis and in those with open mitral commissurotomy. In patients with mitral valve replacement(MVR) whose papillary muscles had been sectioned, the onset of long axis shortening was more delayed during early systole than that of short axis(-33+/-6msec) and the end of shortening was also prolonged to early diastole more than that of normal controls (54+/-3 msec vs 90+/-8 msec, mean+/-SEM, p<0.01 by t-test). CONCLUSION: We observed the time relations between long and short axis motion in normal controls. It can be concluded that the reversed time relation in patients with MVR is one of the important factors which may effect negatively on ventricular function and long-term prognosis, thus the surgical procedures to preserve papillary annular continuity should be considered in patients with mitral valvular disease. And the controlled, prospective, clinical trials with homogenous groups of patients are needed to evaluate the potential benefits of papillary annular continuity in preserving atrio-ventricular interaction in patients undergoing mitral valvular surgery.
Axis, Cervical Vertebra* ; Diastole ; Echocardiography ; Electrocardiography ; Heart Valve Diseases* ; Heart Ventricles ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Papillary Muscles ; Prognosis ; Systole ; Ventricular Function

OBJECTIVE: To evaluate effects of the electrical stimulation to the sacral dermatomes for the neurogenic bowel of the spinal cord injured patients. METHOD: Eleven patients with cervical and thoracic cord injury were enrolled, and classified into two groups, control and electrical stimulation (ES) group. The colon transit time before and after electrical stimulation for 4 weeks to the sacral dermatomes were measured on the ES group, and measured at the same time on control group. The rectoanal manometries were performed after studies of colon transit time on the ES group. RESULTS: The colon transit time measured before electrical stimulation were 16.1+/-13.8 hours for the right colon; 20.1+/-23.3 hours for the left colon; 14.7+/-12.3 hours for the rectosigmoid colon; and the total transit time was 51.0+/-23.4 hours. The time of after electrical stimulation was 8.0+/-5.7 hours for the right colon; 12.8+/-2.2 hours for the left colon; 15.4+/-13.8 hours for the rectosigmoid colon; and the total transit time was 36.2+/-12.8 hours. The left colon transit time and total colon transit time before electrical stimulation were significantly improved compared to after electrical stimulation on the ES group (p<0.05). The left colon transit time of the ES group was significantly improved compared with control group (p<0.05). In the rectoanal manometry, the mean resting anal pressure and threshold of rectoanal inhibitory reflex were increased after the electrical stimulation. CONCLUSION: The electrical stimulation to the sacral dermatomes on the spinal cord injured patient could effectively enhance colon transit, especially on the left colon. In addition, muscular activity of the anal sphincter was enhanced.
Anal Canal ; Colon ; Control Groups ; Electric Stimulation* ; Humans ; Manometry ; Neurogenic Bowel* ; Reflex ; Spinal Cord Injuries ; Spinal Cord*

OBJECTIVE: To evaluate changes of colon transit time according to prokinetic medication and characteristics of the anorectal manometry in patients with neurogenic bowel due to spinal cord injury. METHOD: Twelve patients with cervical and thoracic cord injury were enrolled, and classified into complete and incomplete spinal cord injury according to the severity of injury. The colon transit time before and after prokinetic medications were measured. The anorectal manometry was performed after the first study of colon transit time. RESULTS: The colon transit time of pre-prokinetic medications were 17.1+/-12.6 hours for the right colon, 26.9+/-13.2 for the left colon, 21.5+/-14.0 for the rectosigmoid colon, and the total transit time was 65.5+/-5.3 hours. The time of post-prokinetic medications was 14.3+/-7.6 hours for the right colon, 25.8+/-10.3 for the left colon, 7.4+/-5.3 for the rectosigmoid colon, and the total transit time was 33.1+/-11.5 hours. The rectosigmoid colon transit time and total colon transit time were significantly different between pre- and post-prokinetic medications (p<0.05). In the anorectal manometry, mean resting anal pressure was 33.3+/-10.7 mmHg and maximal resting anal pressure was 99.0+/-43.4 mmHg. There were no difference in the colon transit time and anorectal manometry between complete and incomplete injured patients. CONCLUSION: The difficulties of defecation in spinal cord injured patients were not only due to uncontrolled anal sphincter but also due to dysfunction of colon motility. The prokinetic medications were effective in reducting the rectosigmoid and total colon transit time.
Anal Canal ; Colon* ; Defecation ; Humans ; Manometry* ; Neurogenic Bowel* ; Spinal Cord Injuries ; Spinal Cord*