No abstract available.
Dinoprostone* ; Suppositories*

BACKGROUND: Ventilator associated pneumonia (VAP) is the most serious nosocomial infection of intensive care units. Several studies have investigated the relationship between the interval of ventilator circuit changes and the incidence of pneumonia in foreign countries, but there are no reports about it in Korea yet. So we performed this study to compare the clinical and cost impact between 3 days and 7 days interval in ventilator circuit changes. METHODS: Seoul National University Hospital is a 1,500-bed, university affiliated, tertiary and acute care hospital. All patients admitted to medical intensive care unit (MICU) and surgical intensive care unlt (SICU) between April 1, 1998 and October 31, 1998, requiring mechanical ventilation were included. Patients were divided into two groups of a-cay circuit changes and weekly changes. Daily surveillance was conducted using the criteria of VAP of the National Nosocomial Infection Surveillance System. Incidence of VAP and risk factors for VAP were evaluated. Standard microbiologic methods were used for the identification of clinical and environmental isolates. Statistical analysis was done by SAS Program (version 6.12), analysis of difference in variables was performed using chi-square test and t-test. Analysis of odds ratios was done with logistic regression analysis. RESULTS: VAP developed at a rate of 12.2 per 1,000 ventilator-days in the 3 days change group and 15.6 per 1,000 ventilator-days in the weekly change group (P=0.7240). The only statistically significant risk factor of VAP was duration of mechanical ventilation, The risk of VAP in patients with more than 7 days was 2.23 times higher than in patients with 7 days and below (OR; 2.2296). Estimated annual savings of nursing time by extending ventilator circuit change interval from 3 days to 7 days were 26,806 min 48 sec and estimated savings of cost by reduction of nursing times was calculated as 6,701,700 won. CONCLUSIONS: Weekly ventilator circuit changes in patients undergoing ventilation therapy in the ICU do not contribute to increased the rates of VAP and are cost-effective.
Cross Infection ; Humans ; Incidence ; Income ; Critical Care ; Intensive Care Units ; Korea ; Logistic Models ; Nursing ; Odds Ratio ; Pneumonia ; Pneumonia, Ventilator-Associated* ; Prospective Studies* ; Respiration, Artificial ; Risk Factors ; Seoul ; Ventilation ; Ventilators, Mechanical

Aplastic anemia is characterized by a failure of blood cell production resulting in varying degrees of pancytopenia with a markedly hypocellular bone marrow. Most cases of aplastic anemia are acquired, but the disease may also occur as the result of inherited abnormalities. In 50-65% of cases, however, the etiology is unknown. For acquired forms of aplastic anemia, a variety of causative factors, including radiation, viruses, chemicals and drugs, have been implicated. Antithyroid drugs(Carbimazole, Methimazole, Propylthiouracil) are usually listed among agents associated with the development of agranulocytosis, but aplastic anemia rarely follows their use. The first case of aplastic anemia followmg propylthiouracil was reported by Marte~lo et al. in 1967 and the second case was by Aksoy and Erdem in 1968. Recently, we experienced two cases of aplastic anemia following propylthiouracil therapy due to Graves disease, so we report here these cases with literature review.
Agranulocytosis ; Anemia, Aplastic* ; Blood Cells ; Bone Marrow ; Graves Disease ; Methimazole ; Pancytopenia ; Propylthiouracil*

Leiomyoma and adenomyosis of the uterus are the most common gynecologic disorders in an enlarged uterus. The characteristic US and MR findings in differentiation between both lesions were prospectively evaluated in 30 patients. Of 30 patients, 15 were leiomyomas, 6 were adenomyosises, 8 were leiomyomas and adenomyosises, and 1 was a normal pregnancy, histologically. The total number of leiomyom nodules were 49 while adenomyosises were 14 (9 diffuse and 5 focal). Among 49 myomas nodules, 36 were correctly diagnosed by sonography. The characteristic US findings of uterine leiomyoma were well defined nodules (36), hypoechoic peripheral rim (16), and whorl-like internal echoes (13). Forty four of the 49 myoma nodules were correctly diagnosed by MRI. The characteristic MR findings of myoma were well defined nodules (43), peripheral low signal intensity rim on T1WI (13) and T2WI (9), and peripheral high signal intensity rim on T2WI (5). Among 14 adenomyosises, 9 were correctly diagnosed by sonography. The characteristic US findings of adenomyosis were diffuse uterine hypertrophy more than 5.5cm in AP diameter with endometrial displacement and no significant echo change in myometrium All 14 adenomyosis as were correctly diagnosed from MRI. On T2WI, adenomyosis appeared as ill defined localized or diffuse thickening of the junctional zone more than 1cm in thickness. It was our conclusion that to differentiate between leiomyoma and adenomyosis focused on should be the detection of existence of nodule in leiomyoma, the primary sign, not on the secondary indirect sign.
Adenomyosis* ; Animals ; Female ; Humans ; Hypertrophy ; Leiomyoma* ; Magnetic Resonance Imaging ; Mice ; Myoma ; Myometrium ; Pregnancy ; Prospective Studies ; Uterus

Purpose: To explore the scope and method of applying standardized nursing terminologies to nursing diagnosis and problems used in nursing practice. Methods: A descriptive study was done with a retrospective analysis of the nursing records of 141,420 patients that were hospitalized in 4 tertiary hospitals. The nursing diagnosis and problems collected from the records were standardized, and the standardized nursing diagnosis and problems cross mapped with NANDA-I, confirmed in a nursing focus group. Results: 65 (67.7%) of the 96 standardized nursing diagnosis and problems were equal with NANDA-I and included in the 10 domains of NANDA-I. Among 86 nursing diagnosis and problems excluded from the cross mapping with NANDA-I, the 63 terms (73.3%) related to surgery/procedure were the most common. Conclusion It is meaningful that multi-tertiary hospital nursing diagnosis and problems were standardized and cross mapping with standard nursing terminologies was performed. As for the method of applying standardized nursing terminologies in nursing practice, it is appropriate to use several standardized nursing terminologies complementarily.

BACKGROUND: Exercise-stress electrocardiography (ECG) is initially recommended for the diagnosis of coronary artery disease. But its value has been questioned in women because of suboptimal diagnostic accuracy. Stress echocardiography had been reported to have comparable test accuracy in women. But the data comparing the diagnostic accuracy of exercise-stress ECG and stress echocardiography directly are few. The aim of the study was to compare the diagnostic accuracy of exercise-stress ECG and dobutamine stress echocardiography (DSE) in Korean women. METHODS: 202 consecutive female patients who presented with chest pain in outpatient clinic, and who underwent treadmill exercise test (TET), DSE and coronary angiography were included for the study. The diagnostic accuracy TET and DSE were calculated by the definition of > 50% or > 75% coronary artery stenosis (CAS). RESULTS: The sensitivity and specificity were higher with DSE (70.4, 94.6%) than TET (53.7, 73.6%) for detection of > 50% CAS. The higher accuracy of DSE was maintained after exclusion of the patients who could not achieve over 85% age predicted heart rate before ischemia induction. DSE also showed greater diagnostic accuracy than TET by > 75% CAS criteria, and in subsets of patient with intermediate pretest probability. CONCLUSION: In the diagnosis of CAS, DSE showed higher accuracy than TET in female patients who presented with chest pain. As well as the test accuracy, adequate stress was more feasible with DSE than TET. These finding suggests DSE may be used as the first-line diagnostic tool in the detection of CAS in women with chest pain.
Ambulatory Care Facilities ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Diagnosis ; Echocardiography, Stress* ; Electrocardiography* ; Exercise Test ; Female ; Head* ; Heart Rate ; Humans ; Ischemia ; Sensitivity and Specificity

Gefitinib is regarded as a relatively safe agent for the treatment of an advanced non-small cell lung cancer (NSCLC). Pulmonary toxicity such as interstitial lung disease associated with gefitinib is uncommon with an estimated all time incidence around 1% worldwide. Moreover, a case of gefitinib associated with pulmonary cystic changes has not been reported yet. In this report we present a case of progressive multiple air cystic changes in both lungs in a patient with NSCLC and intrapulmonary metastases who underwent a gefitinib therapy.
Antineoplastic Agents/*adverse effects ; Brain Neoplasms/secondary ; Carcinoma, Non-Small-Cell Lung/*drug therapy/secondary ; Cysts/*chemically induced ; Female ; Humans ; Lung/pathology ; Lung Diseases/*chemically induced ; Lung Diseases, Interstitial ; Lung Neoplasms/*drug therapy ; Middle Aged ; Quinazolines/*adverse effects

PURPOSE: To determine clinical features, laboratory findings and cardiac abnormalities of high- dose immune globulin(IVIG) retreatment in patients with Kawasaki disease, and to report effectiveness of retreatment. METHODS: Retrospective study of 174 children diagnosed with Kawasaki disease at Ewha Mokdong hospital from March, 1999 to July, 2001. RESULTS: Twenty(11.5%) of 174 patients were retreated with high-dose IVIG. After this, only two patients(1.1%) did not respond to IVIG retreatment. Patients with failure to respond to initial IVIG did not differ from the patients who responded to a single course of IVIG in sex, age, days of fever at initial IVIG and clinical characteristics. Compared with responders with single IVIG treatment, the patients who were retreated had significantly lower albumin(3.7 vs 3.4 g/dL, P< 0.05), higher ALT(118.2 vs 229.3 U/L, P<0.05) and CRP(8.9 vs 13.3 mg/dL, P<0.05). On echocardiography, patients who recieved IVIG retreatment were significantly more likely to have caronary abnormalities(45.0% vs 13.6%, P<0.05). CONCLUSION: Retratment with IVIG for persistent or recurrent fever was safe and effective.
Child ; Echocardiography ; Fever ; Humans ; Immunoglobulins, Intravenous* ; Mucocutaneous Lymph Node Syndrome* ; Retreatment* ; Retrospective Studies

PURPOSE: The aim of this study was to investigate the incidence and contributing factors of nonoliguric hyperkalemia in extremely low birth weight infants (ELBW) within 96 hours after birth in very low birth weight infants. METHODS: The incidence of non-oliguric hyperkalemia and difference of clinical feature between hyperkalemic (>or=7.0 mEq/L) and normokalemic (<7.0 mEq/L) groups were determined by reviewing medical records of 35 extremely low birth weight infants admitted in Samsung Medical Center between Jan. 2001 to Dec. 2001. We analyzed the serum levels of sodium, potassium, fluid intake, urine output, blood gas analysis values, and other factors that influenced serum electrolytes. RESULTS: Among 35 ELBW infants, 11 (31%) was hyperkalemia developed and 4 infants (36%) was associated with cardiac arrythmia. The incidence and onset time of hyperkalemia showed inverse correlation with birth weight and gestational age. Perinatal complications and serum levels of sodium, fluid intake, hourly urine output, and other blood gas analysis were no different in both groups. Dopamine administrations, UAC insertion rate, ICH incidence and base deficit were significantly increased in hyperkalemic group. CONCLUSION: Non-oliguric hyperkalemia is a frequent complication of ELBW infant. Serum potassium should be monitored closely to avoid life threatening cardiac arrhythmia in these infants.
Arrhythmias, Cardiac ; Birth Weight ; Blood Gas Analysis ; Dopamine ; Electrolytes ; Gestational Age ; Humans ; Hyperkalemia* ; Incidence ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Infant, Very Low Birth Weight ; Medical Records ; Parturition ; Potassium ; Sodium

An acute pulmonary embolism (PE) and the apical ballooning syndrome (ABS) are both critical and need proper management during the acute stage. We experienced a case of recurrent severe dyspnea because serious right ventricular dysfunction due to PE and left ventricular dysfunction due to ABS occurred consecutively in the short-term and bedside echocardiography has an important role in management in acute settings.
Dyspnea ; Echocardiography ; Hemorrhage ; Pulmonary Embolism ; Takotsubo Cardiomyopathy ; Ventricular Dysfunction, Left ; Ventricular Dysfunction, Right