BACKGROUND: Compared with conventional routes of delivering potent analgesics to postoperative patients, transdermal administration of fentanyl offers the advantages of simplicity and noninvasiveness. The analgesic efficacy and safty of transdermal fentanyl patch (TDFP) were evaluated postoperatively. METHOD: TDFP releasing 25 mcg/hr (Group 1) or placebo (Group 2) were applied to 40 women 6 hours before total abdominal hysterectomy under the general anesthesia. Postoperatively, self-administered intravenous fentanyl was maintained with a 20-mcg incremental dose and a 10-min. locking interval. Each group was assessed following 48 hours with respects to vital signs, VAS pain scores, hourly-used fentanyl doses, satisfaction scores and side effects. RESULT: VAS observed 24 hours, 36 hours after operation were significantly lower in group 1 than group 2. Hourly-used fentanyl doses were significantly lower in group 1 than group 2 at 2 hours, 6 hours, 12 hours and 24 hours after operation. The incidence of side effects were similar between group 1 and group 2. CONCLUSION: TDFP-25 mcg applied 6 hours before operation provides supplementary analges-ia after the postoperative period without significant side effects such as respiratory depression.
Administration, Cutaneous ; Analgesics ; Anesthesia, General ; Female ; Fentanyl* ; Humans ; Hysterectomy* ; Incidence ; Postoperative Period ; Respiratory Insufficiency ; Vital Signs

No abstract available.
Tetanus*

PURPOSE: The study assessed the effect of exogenous surfactant on oxygen and ventilator requirements and long-term prognosis of neonates with respiratory deterioration due to pulmonary hemorrhage. METHODS: From March 2007 to March 2011, neonates with respiratory deterioration due to pulmonary hemorrhage in Saint Mary's Hospital were identified from the database. Among 20 patients with pulmonary hemorrhage, 10 patients received surfactant therapy and the other 10 did not. We compared outcomes of these two groups. The primary outcome was changes in respiratory status following surfactant therapy, as reflected by oxygen index (OI), fractional inspired oxygen (FiO2) and mean airway pressure (MAP). Secondary outcomes were the duration of ventilation, nasal continuous positive airway pressure (NCPAP), oxygen inhalation days, progression to severe bronchopulmonary dysplasia or death, and retinopathy of prematurity, which required laser therapy. RESULTS: Surfactant treatment group had higher FiO2, MAP, and OI than the non-treatment group during pulmonary hemorrhage. But, there were no differences in FiO2, MAP, and OI after 2 hours of pulmonary hemorrhage between the two groups. There were no significant side effects during surfactant treatment in the surfactant treatment group. Surfactant treatment group had fewer ventilator days, NCPAP days (P<0.05) and a tendency towards shorter oxygen days than the non-treatment group (P=0.09). Also, the surfactant treatment group had less severe bronchopulmonary dysplasia (BPD) or death than the non-treatment group (10% vs. 70%, P<0.05). CONCLUSION: Exogenous surfactant appears to be a useful adjunctive therapy with neonates of severe respiratory deterioration due to pulmonary hemorrhage. Also, exogenous surfactant treatment dose not seen to be associated with any significant side effects during the therapy.
Bronchopulmonary Dysplasia ; Continuous Positive Airway Pressure ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Inhalation ; Lung ; Oxygen ; Prognosis ; Pulmonary Surfactants ; Respiratory Insufficiency ; Retinopathy of Prematurity ; Saints ; Ventilation ; Ventilators, Mechanical

PURPOSE: The staging of bladder carcinoma is a major determinant of operative management. CT of bladder carcinoma has been widely used to diagnose external extension (pT3b and over), but tumors confined to the bladder wall (from pT1 to pT3a) are poorly delineated. The authors describe CT findings of the superficial bladder carcinoma (below T1, stage A) in thin section CT with air insufflation technique (air insufflation-CT) to facilitate early detection and to aid correct staging of the superficial bladder carcinoma. MATERIALS AND METHODS: The materials consisted of proved 24 cases (1'9 patients, single tumor: 16 patients, multiple tumors :3 patients) of stage A bladder carcinomas. Air insufflation-CT was performed by the infusion of approximately 200 mL of air into the bladder via a Foley catheter. After the routine pelvic CT, bladder tumors were re-scanned with 1.5 to 5 mm thickness and intervals. RESULTS: The superficial bladder carcinomas were detected as nodular(5 cases, 20.8%), papillary(15 cases, 62.5%), pyramidal(2 cases, 8.3%), and domed(2 cases, 8.3%) forms on air insufflation CT. These tumors were classified into three types according to the size of the tumoral neck:type I(pedundulated polypold tumor:4 cases, 16.6%), type II(polypid tumor with short neck :13 cases, 54.2%), and type Ill(sessile tumor :7 cases, 29. 2%). The mean size(tumoral width x height x base o, neck/stalk) of the tumors was 22 x 20 x 16mm. The average tumoral sizes according to each type of the superficial tumors were type 1:22 x 25 x 6mm, type 11:23 x 22 x 18mm, and type III :18 x 15 x 18mm. The mean width of the type I--II tumoral necks was 15mm. The mean length of the type I tumoral neck(pedicle) was 2.5mm. Papillary fronds of the tumors were seen in 10 cases(41.7%) of 24 superficial tumors. Outer margin of the involved bladder wall was smooth in all cases. CONCLUSION: Thin-sectin CT with air insufflation technique for bladder carcinoma was useful in tumoral demonstration, and characteristics of the superficial bladder carcinomas were small polypold tumors had a short neck mostly and smooth outer wall of the involved bladder wall.
Catheters ; Humans ; Insufflation* ; Neck ; Urinary Bladder Neoplasms ; Urinary Bladder*

PURPOSE: The aim of this study was to evaluate thyroid dysfunction in obese children in Korea. METHOD: We measured body mass index and thyroid hormone in obese, overweight, and normal weight children who visited a pediatric clinic in Jeonju, Korea, from January 2009 to September 2012. RESULTS: The free thyroxoine (FT4) level of the obese group (16.35 +/- 2.79 pmol/L) was lower than levels of the overweight (17.65 +/- 2.31 pmol/L) and normal weight (17.28 +/- 2.35 pmol/L; P=0.012) groups. The average value of FT4 in severely obese children (15.71 +/- 1.68 pmol/L) was lower than those of mildly and moderately obese children (16.40 +/- 2.88 pmol/L). We found no significant difference in thyroid stimulating hormone level between the obese group and normal weight group. CONCLUSION: The FT4 level is lower in obese children than in normal weight children.
Body Mass Index ; Child ; Humans ; Korea ; Obesity ; Overweight ; Thyroid Gland ; Thyroid Hormones ; Thyrotropin

PURPOSE: This study was designed to examine the effect of asthma management education program applied to allergic asthma patients receiving immunotherapy due to house dust mite on their stress and compliance with health care regimens. METHODS: A quasi experimental design with non-equivalent control group and non-synchronized design was used. The subjects of this study were 61 patients who were receiving immunotherapy at intervals of a week after their symptoms were diagnosed as house dust mite allergic asthma at the pulmonary department of a university hospital in Seoul. They were divided into an experimental group of 29 patients who received asthma management education and a control group of 32 patients. The asthma management education program was composed of group education (once) and reinforcement education (three times) with environmental therapy and immunotherapy to house dust mite. RESULTS: Stress significantly decreased in the experimental group compared to that in the control group. Compliance with health care regimens significantly increased in the experimental group compared to that in the control group. CONCLUSIONS: The results suggested that the asthma management education program is effective for the management of stress and the improvement of compliance in patients with allergic asthma to house dust mite.
Stress, Psychological/etiology/*prevention & control ; Pyroglyphidae/*immunology ; *Patient Education ; *Patient Compliance ; Male ; Korea ; Humans ; Female ; Asthma/etiology/psychology/*therapy ; Adult

BACKGROUND: Early esophageal cancer has a good prognosis compared with advanced esophageal cancer, so early detection of the cancer is emphasized. Early esophageal cancer is considered as esophageal cancer located within the submucosal layer and without metastasis in the operative specimen. Despite this criterion, evidence has accumulated suggesting that submucosal tumors have a very different prognosis from intra-epithelial and intramucosal lesions. The purpose of this study is to define the characteristics of and the appropriate operative method for esophageal cancer. METHODS: Medical records of 19 patients who had received an esophagectomy and who had been diagnosed as having early esophageal cancer between 1981 and 1996 at this hospital were reviewed. RESULTS: There was 17 cases of submucosal lesions and 2 cases of mucosal lesions. 74% of the patients had alcohol or smoking history. When endoscopic findings were classified according to the endoscopic classification of JSED, there were 5 cases of type 0-I, 4 cases of type 0-III, 4 cases of type 1, and others. Type 0-I and 0-III were common. The accuracy of the endoscopic ultrasonographic finding was 39% compared with the postoperative pathologic finding. The mean duration of follow-up was 21 months, and there were 2 recurrences during follow-up. One recurred 13 months after the operation and the other 23 months after the operation. Both of them were submucosal lesions and received a transhiatal esophagectomy. CONCLUSIONS: Annual endoscopic examination with lugol staining may be needed for early detection of esophageal cancer. Submucosal lesions of early esophageal cancer should be managed with an esophagectomy and lymph node dissection. Also, expertness of the endoscopist is very important in deciding on an of operative method.
Classification ; Esophageal Neoplasms* ; Esophagectomy ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Smoke ; Smoking

Thyroid carcinogenesis is traditionally thought to originate 'de novo'. However, it is debatable whether a malignant transformation can possibly arise from a benign thyroid nodule, as suggested for the malignant transformation of a thyroid adenoma. To the best of our knowledge, no studies have been performed addressing the malignant transformation of nodular hyperplasia in the thyroid gland. Here, we report a case of nodular hyperplasia with focally malignant degeneration.
Carcinogenesis ; Cell Transformation, Neoplastic ; Focal Nodular Hyperplasia ; Hyperplasia* ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule

PURPOSE: Nurses' resilience plays an important role in overcoming the challenges that nurses often encounter at clinic, and many factors have been examined which influence on nurses' resilience levels. Through this study, those factors were systematically searched and quantitatively synthesized. METHODS: In order to find relevant studies, both English and Korean academic databases were searched, and, finally, a total of 33 articles were identified and included in this analysis. RESULTS: The effect size on the protective variables was large and that of the risk variables was medium. In the protective variable group, the job variable group showed a larger effect size compared to the organizational variable group. Among the protective variables, compassion satisfaction showed the highest contribution on enhancing the resilience level of nurses. In the risk variable group, the personal variable group showed the highest effect size, which was followed by the organizational and job variables. Among the risk variables, the personal stress response showed the highest contribution to decreasing the level of resilience of nurses. CONCLUSION: This study provides a meaningful data for future studies in terms of developing evidence-based interventions to enhance the levels of resilience among Korean nurses.
Empathy ; Humans