This study was conducted with the subject of showing the importance of early rehabilitation and exercise therapy in patients who have stroke, of confirming the advantage of ward exercise conducted by nurse, which had been conducted mainly by physical therapist only in physical therapy room and of developing the exercise program as the independent rehabilitation nursing intervention. A total of 62 patients were selected as object from April, 5th, to May, 17th, 1995, who had been hospitalized in K medical center, and the half of them were assigned to Experimental group in random assignment using a coin. It was ADL check list tool developed by Kang and Ward Exercise Program developed by the researcher that were used as a treatment. Ward Exercise Program was conducted by the researcher and the physical therapist measured ADL score before and after Ward Exercise program. The data were analyzed using ANOVA, pearson correlation, Chi-Square test and the effect of Ward Exercise Program was analyzed by t-test. The result of this study is as follows : 1. The experimental group showed eminent improvement of ADL compared with the counter group with statistical significance. In eating(t=6.10, p=.000), personal hygiene performing(t=4.86, df=60, p=.000), wearing(t=5,86, df=60, p=.000), elimination(t=7.89, df=60, p=.000), mobility on the bed(t=13.36, df=60, p=.000), moving(t=9.11, df=60, p=.000), walking(t=7.45, df=60, p=.000) 2. There was no qualitative difference between experimental group and control group with the significance of p< or =.05. 3. There was no relation between the general condition and the difference of ADL, while there was significant relation between the starting point of exercise and the difference of pre-exercise and post exercise ADL. As a result, it should be emphasized that the early rehabilitation and exercise therapy are important in patients who have stroke, and that it is necessary to extend the exercise therapy to the ward. Therefore, this Ward Exercise Program could be recommended as a independent clinical exercise nursing intervention in rehabilitation nursing of patients who have stroke.
Activities of Daily Living ; Exercise Therapy ; Humans ; Hygiene ; Numismatics ; Nursing ; Physical Therapists ; Rehabilitation ; Rehabilitation Nursing ; Stroke*

Since patients who have suffered from strokes have chronic health problems, the development of a protocol for home care nursing is required. Therefore, this study was done to test the effects of such a protocol on stroke patients. This study was conducted by using a single group pre-post design. The subjects for the study were 13 home care nurses and 30 home care patients who had a stroke. Data collection was done from October 1997 to February 1998. The collected data was analyzed using the Wilcoxon signed rank test and paired t-test and the results were as follows : 1. The first hypothesis that "working satisfaction of home nurses would be higher after using the home care protocol" was supported. 2. The second hypothesis that "patients" satisfaction would be higher after using the home care protocol" was rejected. 3. The third hypothesis that "the level of ADL of patients would be higher after using the home care protocol" was supported. In conclusion, by using a home care protocol, the satisfaction of nurses' work and the ADL of patients increased, and the patients' satisfaction also increased without statistical significance. The above results confirm that the application of a home care protocol is very effective. Thus, this protocol can be helpful in the quality care of stroke patients. Therefore, developing and organizing protocols, according to health problem, can be useful for beginner nurses who interact with high risk patients.
Activities of Daily Living ; Data Collection ; Home Care Services* ; Humans ; Nurses, Community Health ; Nursing Care* ; Nursing* ; Stroke*

The fetus is an unstable subject for an isolated physiological and biochemical study. To study the fetus in a controlled and stable environment, a trial was done using 12 goat fetuses. Extrauterine incubation system was devised using an extracorporeal membrane oxygenation system. The system consisted of a venous reservoir with a servo-controlled roller pump and a membrane oxygenator. The extra-corporeal circuit and membrane oxygenator were primed with the maternal whole blood of 200 mL. Fetal umbilical cords was exposed by Cesarean section. Fetal umbilical arterial blood was drained via the drainage cannula. The drained blood was perfused to the oxygenator by the roller pump. The highly oxygenated and decarboxylated blood was returned to an umbilical vein via the perfusion catheter. The blood flow rate was controlled manually using a roller pump. Fetal heart rate, blood pressure, and electrocardiogram were continuously recorded. Gas analysis of drained and perfused bood was performed hourly. With this system, the fetuses were able to survive under fairly stable physiological condition for periods of up to 34 hr. The extrauterine incubation system used in this study could therefore be a encouraging future experimental model in researching the artificial placenta for premature fetuses.
Animals ; Extracorporeal Membrane Oxygenation/adverse effects/*methods ; Female ; Fetal Blood/metabolism ; Fetus/*blood supply/*physiology ; Goats ; Humans ; Infant, Newborn ; Infant, Premature ; Models, Animal ; Pregnancy ; Time Factors ; Umbilical Arteries ; Umbilical Veins

A 31-year-old woman admitted because of fever, chilling and sore throat for 4 days. The symptom was developed after receiving methimazole 20mg per day and carteolol 10mg per day due to Graves disease during last 4 weeks. Physical examination revealed hyperemic enlarged tonsils with whitish plaque. The peripheral blood total neutrophil count was 1,400/mm3 (absolute neutrophil count, ANC 36) and a peripheral blood smear revealed rare neutrophil with lymphocytosis. On the first day of hospitalization, the patient was severely ill with ANC 0, it was decided to administer G-CSF 2ug/kg daily. On the fifth day of hospitalization, ANC in peripheral blood count was persistently zero and bone marrow aspiration and biopsy were performed, which revealed hypocellularity and myeloid hypoplasia. G-CSF given daily for 7days, it was discontinued when the ANC reached 1,539/mm3. The availability of G-CSF may help to shorten the course of agranulocytosis and to reduce its mortality rate.
Adult ; Agranulocytosis* ; Biopsy ; Bone Marrow ; Carteolol ; Colony-Stimulating Factors* ; Female ; Fever ; Granulocyte Colony-Stimulating Factor* ; Granulocytes* ; Graves Disease ; Hospitalization ; Humans ; Lymphocytosis ; Methimazole* ; Mortality ; Neutrophils ; Palatine Tonsil ; Pharyngitis ; Physical Examination

BACKGROUND: The extrauterine fetal incubation system must meet stable blood gas exchange and sufficient oxygen supply to provide the physiologic oxygen consumption of the fetus. In the fetus, blood gas exchange is totally sustained by the placental circulation. The placenta can be regarded as an extracorporeal organ, and the basic structure of placental circulation comprises arteriovenous (AV) bypass. To mimic this mode of circulation, we used AV ECMO (extracorporeal membrane oxygenation) in the goat fetus, and attempted to achieve stable blood gas exchange and oxygen supply to the fetus. METHODS: Pregnant goats, weighting 30 - 35 kg, were anesthetized with N2O-O2-enflurane. We performed a cesarean section with a midline incision, and cannulated via the umbilical vessels after a hysterotomy, and connected the fetuses to an ECMO circuit. The fetus was transferred to an incubator containing normal saline mixed with antibiotics. Blood samples were obtained every 4 to 6 hours from the circuit for electrolytes, hemoglobin and blood gas analysis and arterial blood pressure and heart rate were monitored through the umbilical artery. Oxygen delivery and consumption were calculated from the measured parameters. Microscopic examinations of the liver, kidney and lung were performed 24 hours after ECMO to know the effect of AV ECMO on the circulation of the organ. RESULTS: AV ECMO was done for 24 hours in the six goat fetuses and the main cause of death was circulatory failure. Heart rates and blood pressure were stable during ECMO. Sodium bicarbonate was injected when mild acidosis occurred and blood gas exchange was maintained stable. Mean pump flow rate was 156 +/- 62 ml/min/kg and oxygen extraction ratio was 30.4%. The liver function tests were sustained within normal limits both before and 24 hours after ECMO, but BUN and creatininincreased beyond upper normal limits 24 hours after ECMO. Microscopic features of the liver and kidney showed congestion 24 hours after ECMO. The fetal lung after 24 hours of ECMO especially showed an increase of mature capillaries in the septum and wall of alveoli compared with the twin fetal lung. CONCLUSIONS: These results indicate that the extrauterine fetal incubation model used for this study was suitable to blood gas exchange and utility of oxygen for goat fetuses.
Acidosis ; Anti-Bacterial Agents ; Arterial Pressure ; Blood Gas Analysis ; Blood Pressure ; Capillaries ; Cause of Death ; Cesarean Section ; Electrolytes ; Estrogens, Conjugated (USP) ; Extracorporeal Membrane Oxygenation ; Female ; Fetus* ; Goats* ; Heart Rate ; Hemodynamics ; Humans ; Hysterotomy ; Incubators ; Kidney ; Liver ; Liver Function Tests ; Lung ; Membranes ; Oxygen ; Oxygen Consumption ; Placenta ; Placental Circulation ; Pregnancy ; Shock ; Sodium Bicarbonate ; Twins ; Umbilical Arteries

OBJECTIVES: The purpose of this study is to establish animal model of extracorporeal membrane oxygenation (ECMO) system that uses membreane type oxygenator and circulation circuit of umbilical artery and vein. Blood gas and hemodynamic changes in the fetal goat undergoing ECMO were also evaluated. METHODS: Total 15 pregnant goat had been used to perform extrauterine fetal incubation using ECMO through umbilical artery and vein. Cesarean-section was performed to pregnant goat (35 kg) of 120-130 days of gestation to insert catheters (8 Fr) into the umbilical artery and vein. The tip of inserted catheter's the other end was connected with the circuit system including membrane type oxygenator (Polystan) and roller pump. A total of 300 ml of blood was drawn from donor nonpregnant goat and primed into circuit on the day of surgery. The goat fetus was immersed in a chamber filled with artificial amniotic fluid to monitor blood flow dynamics and blood gas was analyzed. RESULTS: The ECMO system using umbilical cord in the extrauterine incubation of fetal goat was developed and maximum survival of goat fetus was 34.5 hrs (mean survival was 856.6+/-688 min). Oxygen tension (PO2) in umbilical artery and vein were 20.53+/-2.54 mmHg, 31.03+/-13.03 mmHg and oxygen saturation (SO2) in umbilical artery and vein were 46.61+/-18.14 mmHg, 71.56+/-15.39 mmHg. Mean blood flow was 176+/-62 ml/min/kg. CONCLUSION: We suggest that our experimental model as an extrauterine fetal research could be a reasonable method in future advanced studies. However, longterm survival of extrauterine fetus needs more suitable hemodynamic and blood gas condition supported by further researches.
Amniotic Fluid ; Catheters ; Extracorporeal Membrane Oxygenation* ; Female ; Fetal Research ; Fetus ; Goats* ; Hemodynamics* ; Humans ; Membranes ; Models, Animal ; Models, Theoretical ; Oxygen ; Oxygenators ; Pregnancy ; Tissue Donors ; Umbilical Arteries* ; Umbilical Cord ; Veins*

Hemangioma is one of the most common tumor in the region of the head and neck. There are many methods were tried for the treatment of hemangioma, however no single satisfactory method was introduced. The hemangioma which arised from the external ear are rare. Authors report three cases of the hemangioma which involved the external ear. The hemangioma was aesthetically treated with surgical reduction and ligation
Ear, External* ; Head ; Hemangioma* ; Ligation* ; Neck

Inversion of nipple is a common condition occurring with an incidence of 2% in women. It not only causes irritation and inflammation, but also causes aesthetic problems, affecting sexual relationships and psychological well-being of the patients. Several methods have been introduced to treat this condition in the past century, but the major principle of correction is based on the concept suggested by Schwager, that inverted nipple develops because of the lack of connective tissue located directly beneath the nipple. Based on this concept, many surgeons including Broadbent, Teimourian, and Elshy etc. have proposed that adding bulk of connective tissue and scarifing the ductal system is the principle of the treatment. Author`s method is also based on such a concept, and we have modified the Teimourian method. First, an intraglandular section in the shape of an inverted cone was performed. The crator-like glandular section was closed using horizontal mattress suture, leading to circumglandular V-Y advancement. Second, the donor sites on the areolar area were closed with V-Y advancement. Third, purse-string suture was performed to achieve neck tightening and to compensate for the lack of connective tissue beneath the nipple. Dermal flap suture was done by Foot-plate manner. We operated on 52 cases using this method, 28 patients during past 2 years. After 1 year following the operation, there were just two cases of relapse and virtually no complications. We obtained satisfactory projection of the nipples in all patients except in 2 cases. The resulting shapes and scars were acceptable to all patients.
Cicatrix ; Connective Tissue ; Female ; Humans ; Incidence ; Inflammation ; Neck ; Nipples* ; Recurrence ; Sutures ; Tissue Donors

Benign symmetrical lipomatosis, also known as Madelung's disease, is a rare condition characterized by massive fatty deposits arranged symmetrically around the neck, shoulders, and arms. Patients usually complain of their cosmetic appearance, but treatment can be considered for decreased neck motion and/or aerodigestive problems. Surgical lipectomy and liposuction are treatment of choice, but recurrence is common. Because the distribution of the lesion tends to be wide and diffuse, single operation is not sufficient for improving contour and functional problems, especially in severely affected case. We experienced a progressed patient who suffered from limitation of neck motion, dyspnea including sleep apnea due to massive deposits on whole neck. We performed 2 staged operations for the purpose of removing as much lipomatous tissue as possible. After 2 staged excisions, patient's appearance and aerodigestive problems are much improved and recurrence is not observed.
Arm ; Dyspnea ; Humans ; Lipectomy ; Lipomatosis ; Lipomatosis, Multiple Symmetrical* ; Neck ; Recurrence ; Shoulder ; Sleep Apnea Syndromes

PURPOSE: Myoepithelioma is a rare tumor that originates exclusively from myoepithelial cells of the salivary glands, breast and the prostate. Myoepithelioma accounts for less than 1% of all salivary gland tumors. The objective of our study is to present our experience of the infra- auricular mass which was finally diagnosed as a myoepithelioma. METHODS: A 54-year-old woman was presented with a firm, movable, slow-growing infra-auricular mass with 3 cm in diameter. MRI scans and fine needle biopsy was performed for preoperative diagnostic study. A superficial parotidectomy was preceded and removed tumor successfully. RESULTS: Histopathological study revealed a myoepithelioma of plasmacytoid type. Patient's postoperative course was uneventful without any complication and had no evidence of recurrence of tumor for 9 months follow- up period. CONCLUSION: Myoepithelioma in the parotid gland shows similar clinical courses and intraoperative finding to the pleomorphic adenoma and superficial parotidectomy was selective choice for treatment.
Adenoma, Pleomorphic ; Biopsy, Fine-Needle ; Breast ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Myoepithelioma* ; Parotid Gland* ; Prostate ; Recurrence ; Salivary Glands