The purpose of this study was to identify risk factors predictive of alterations in skin integrity during the intraoperative period. The predictive risk factors were studied for intraoperative pressure sores from December 1998 through January 1999. A sample of 220 patients was selected from the operating room schedule of a University Hospital in Pusan. There were two criteria in including patients : the operation lasted longer than 2 hours and the absence of skin break down according to NPUAP criteria. The data were analyzed by SPSS/PC, Stepwise multiple logistic regression was used to identify the variables which were predictive of alterations in skin integrity. Of the 220 patients studied, 41 patients(18.6%) developed stage 1 pressure sores in the immediate postoperative period. In relation to skin changes, three independent variables emerged from the stepwise multiple logistic regression as being significant(p<0.05). Factors predictive of pressure sore formation included low serum albumin(p=0.000), prone position while undergoing surgery(p=0.0004), time on the operating table(p=0.0165). Among the intrinsic factors, serum albumin was the most significant causal factor in pressure sores development in the intraoperative period. Pressure and shearing force were the most significant extrinsic factors in pressure sores development. From the results of this study we conclude that the primary nursing goal is the maintenance of the proper patient' position during the intraoperative period. Also imperative for sore prevention is the reduction of surgery time and improving preoperative nutritional status.
Appointments and Schedules ; Busan ; Humans ; Intraoperative Period ; Intrinsic Factor ; Logistic Models ; Nutritional Status ; Operating Rooms ; Postoperative Period ; Pressure Ulcer* ; Primary Nursing ; Prone Position ; Prospective Studies* ; Risk Factors* ; Serum Albumin ; Skin

BACKGROUND AND OBJECTIVES: It has been demonstrated that sleep apnea syndrome predisposes to cardiac rhythm disturbances and cardiovascular risks such as systemic hypertension. This study was conducted to investigate the types and frequency of cardiac arrhythmias which occurred during sleep and the effects of nasal continuous positive airway pressure (nCPAP) therapy in the patients with sleep apnea syndrome. SUBJECTS AND METHODS: The subjects were 197 patients who were referred to the Sleep Research Center of Korea University Medical Center for polysomnography due to snoring and sleep apnea from Jan. 1st 2000 to July 31st 2002. Of the 197 patients, 44 with severe sleep apnea syndrome, whose respiratory disturbance index (RDI) exceeded 40/hr, were enrolled. Their electrograms on polysomnography before and after nCPAP therapy were analyzed. RESULTS: Of the 44 subjects, 32 (72.8%) showed cardiac arrhythmias. The types of arrhythmias were atrial premature beats (APBs, n=17), premature ventricular complexes (PVCs, n=15), sinus bradycardia (heart rate less than 40 per minute, n=6), sinus pause (n=1), and sinoatrial block (n=5). No fatal arrhythmias were identified. Most, 93.2%, of these arrhythmias arose immediately after hypopneic or apneic episodes, and were accompanied by a significant decrease in SaO2, from 91.4% to 84.7% (p<0.05). After nCPAP therapy, these arrhythmias were completely disappeared in 11 patients (34.4%) and diminished in 15 (46.9%). Hypopneic or apneic episodes were preceded by cardiac arrhythmias in only 36.4% with nCPAP (p<0.05 vs. before). CONCLUSION: Cardiac arrhythmias were demonstrated in 72.8% of cases of severe sleep apnea syndrome, which were mostly benign and preceded by hypopneic or apneic episodes. nCPAP therapy decreased the frequency of hypopnea and apnea with elevated arterial O2 saturation, and effectively eliminated cardiac arrhythmias.
Academic Medical Centers ; Apnea ; Arrhythmias, Cardiac ; Bradycardia ; Cardiac Complexes, Premature ; Continuous Positive Airway Pressure ; Humans ; Hypertension ; Korea ; Polysomnography ; Positive-Pressure Respiration ; Sinoatrial Block ; Sleep Apnea Syndromes* ; Snoring ; Ventricular Premature Complexes

Congenital anomalies of the female reproductive tract may involve the uterus, cervix, fallopian tubes, or vagian. Depending on the specific defect, a women's obstetric and gynecologic health may be adversely affected. We have experienced a case of rudimentary uterine horn with noncommunicated uterus complicated by pelvic endometriosis in a 25 years old woman with primary amenorrhea and monthly periodic pelvic pain. We observed noncommunicating uterus with blind pouch, cervix disconnected to uterus with normal appearance, and left ovarian endometrial cyst. For treatment, the metroplastic surgery with end-to end anastomosis connecting cervix and noncommunicated uterus and removal of endometrial cyst were done. Many cases of uterine anomalies have been documented but, there have been few reported cases of noncommunicated uterus with disconnected cervix and successful performance of the metroplasty. Thus hereby we report this case with a review of literatures.
Amenorrhea ; Animals ; Cervix Uteri ; Endometriosis ; Fallopian Tubes ; Female ; Horns ; Humans ; Pelvic Pain ; Urogenital Abnormalities ; Uterus

Purpose: To evaluate whether the added value of contrast leakage information from dynamic susceptibility contrast magnetic resonance imaging (DSC MRI) is a better prognostic imaging biomarker than the cerebral blood volume (CBV) value in distinguishing true progression from pseudoprogression in glioblastoma patients. Materials and Methods: Forty-nine glioblastoma patients who had undergone MRI after concurrent chemoradiotherapy with temozolomide were enrolled in this retrospective study. Twenty features were extracted from the normalized relative CBV (nCBV) and extraction fraction (EF) map of the contrast-enhancing region in each patient. After univariable analysis, we used multivariable stepwise logistic regression analysis to identify significant predictors for differentiating between pseudoprogression and true progression. Receiver operating characteristic (ROC) analysis was employed to determine the best cutoff values for the nCBV and EF features. Finally, leave-one-out cross-validation was used to validate the best predictor in differentiating between true progression and pseudoprogression. Results: Multivariable stepwise logistic regression analysis showed that MGMT (O 6 -methylguanine-DNA methyltransferase) and EF max were independent differentiating variables (P = 0.004 and P = 0.02, respectively). ROC analysis yielded the best cutoff value of 95.75 for the EF max value for differentiating the two groups (sensitivity, 61%; specificity, 84.6%; AUC, 0.681 ± 0.08; 95% CI, 0.524-0.837; P = 0.03). In the leave-one-out cross-validation of the EF max value, the cross-validated values for predicting true progression and pseudoprogression accuracies were 69.4% and 71.4%,respectively. Conclusion We demonstrated that contrast leakage information parameter from DSC MRI showed significance in differentiating true progression from pseudoprogression in glioblastoma patients.

Objective: To develop a radiomics risk score based on dynamic contrast-enhanced (DCE) MRI for prognosis prediction in patients with glioblastoma. Materials and Methods: One hundred and fifty patients (92 male [61.3%]; mean age ± standard deviation, 60.5 ± 13.5 years) with glioblastoma who underwent preoperative MRI were enrolled in the study. Six hundred and forty-two radiomic features were extracted from volume transfer constant (Ktrans), fractional volume of vascular plasma space (Vp), and fractional volume of extravascular extracellular space (Ve) maps of DCE MRI, wherein the regions of interest were based on both T1-weighted contrast-enhancing areas and non-enhancing T2 hyperintense areas. Using feature selection algorithms, salient radiomic features were selected from the 642 features. Next, a radiomics risk score was developed using a weighted combination of the selected features in the discovery set (n = 105); the risk score was validated in the validation set (n = 45) by investigating the difference in prognosis between the “radiomics risk score” groups. Finally, multivariable Cox regression analysis for progression-free survival was performed using the radiomics risk score and clinical variables as covariates. Results: 16 radiomic features obtained from non-enhancing T2 hyperintense areas were selected among the 642 features identified. The radiomics risk score was used to stratify high- and low-risk groups in both the discovery and validation sets (both p < 0.001 by the log-rank test). The radiomics risk score and presence of isocitrate dehydrogenase (IDH) mutation showed independent associations with progression-free survival in opposite directions (hazard ratio, 3.56; p = 0.004 and hazard ratio, 0.34; p = 0.022, respectively). Conclusion We developed and validated the “radiomics risk score” from the features of DCE MRI based on non-enhancing T2 hyperintense areas for risk stratification of patients with glioblastoma. It was associated with progression-free survival independently of IDH mutation status.

Objective: To develop a radiomics risk score based on dynamic contrast-enhanced (DCE) MRI for prognosis prediction in patients with glioblastoma. Materials and Methods: One hundred and fifty patients (92 male [61.3%]; mean age ± standard deviation, 60.5 ± 13.5 years) with glioblastoma who underwent preoperative MRI were enrolled in the study. Six hundred and forty-two radiomic features were extracted from volume transfer constant (Ktrans), fractional volume of vascular plasma space (Vp), and fractional volume of extravascular extracellular space (Ve) maps of DCE MRI, wherein the regions of interest were based on both T1-weighted contrast-enhancing areas and non-enhancing T2 hyperintense areas. Using feature selection algorithms, salient radiomic features were selected from the 642 features. Next, a radiomics risk score was developed using a weighted combination of the selected features in the discovery set (n = 105); the risk score was validated in the validation set (n = 45) by investigating the difference in prognosis between the “radiomics risk score” groups. Finally, multivariable Cox regression analysis for progression-free survival was performed using the radiomics risk score and clinical variables as covariates. Results: 16 radiomic features obtained from non-enhancing T2 hyperintense areas were selected among the 642 features identified. The radiomics risk score was used to stratify high- and low-risk groups in both the discovery and validation sets (both p < 0.001 by the log-rank test). The radiomics risk score and presence of isocitrate dehydrogenase (IDH) mutation showed independent associations with progression-free survival in opposite directions (hazard ratio, 3.56; p = 0.004 and hazard ratio, 0.34; p = 0.022, respectively). Conclusion We developed and validated the “radiomics risk score” from the features of DCE MRI based on non-enhancing T2 hyperintense areas for risk stratification of patients with glioblastoma. It was associated with progression-free survival independently of IDH mutation status.