It would seem logical that a left to right shunt may be localized to that chamber in which an increase in oxygen content beyond the normal variation is first seen, while this is generally true, there are certain limitations to such direct diagnostic interpretation. The interpretation of an observed difference in oxygen content is influenced by the result of extremely poor mixing or of a change in respiratory, circulatory or metabolic steady states. This is one of the major challenges to proper interpretation. The purpose of this study was to analyze the blood oxygen content in various chambers of the right side of the heart in patients without shunt and to study the difference in oxygen content between the various chambers. The right heart catheterization was performed in 19 cardiac patients without shunt in Cardiac Laboratory in Hospital. 1. The blood oxygen content was 12.36+/-2.23 volume per cent (mean+/-standard error) in superior vena vava, 12.59+/-2.23 volume per cent in inferior vena cava, 12.59+/-2.23 volume per cent in mid-right atrium, 12.92+/-1.90 volume per cent in mid-right ventricle and 12.26+/-2.13 volume per cent in main pulmonary artery. 2. The mean difference of oxygen content was 0.16 volume per cent between superior vena cava and right atrium, 0.08 volume per cent between right atrium and right ventricle, and 0.06 volume per cent between right ventricle and main pulmonary artery.

No abstract available.
Child* ; Humans ; Lung*

The hyperosinophilic syndrome (HES) commonly involves liver and spleen but only a few literature has reported the imaging features. In this article, we present the imaging features of the liver and spleen in HES patients together with clinical and laboratory features. This study included 5 HES patients with hepatic involvement. Extensive laboratory tests including multiple hematologic, serologic, parasitologic, and immunologic examinations were performed. Imaging studies included CT, ultrasound (US) of upper abdomen and hepatosplenic scintigraphy. All patients were periodically examined by laboratory and imaging studies for 4 to 24 months. The common clinical presentations were weakness, mild fever, and dry cough. All patients revealed leukocytosis with eosinophilia of 40 to 80% and benign eosnophilic hyperplasia of the bone marrow. The percutaneous biopsy of the hepatic focal lesions performed in 2 patients showed numerous benign eosinophilic infiltrates and one of them revealed combined centrilobular necrosis of hepatocytes. All cases revealed hepatomegaly with multiple focal lesions on at least one of CT, US, or scintigraphy. These findings completely disappeared in 2 To 6 months following medication of corticosteroid or antihistamines. The HES involved the liver and CT, US, or scintigraphy. These findings completelydisappeared in 2 to 6 months following medication of corticosteroid or antihistamines. The HES involved the liver and CT, US, or scintigraphic studies showed hepatic multifocal lesions with hepatomegaly. Differential diagnoses of these findings should include metastatic disease, lymphoma, leukemia. candidiasis or other opportunistic infections.
Abdomen ; Biopsy ; Bone Marrow ; Candidiasis ; Cough ; Diagnosis, Differential ; Eosinophilia ; Eosinophils ; Fever ; Hepatocytes ; Hepatomegaly ; Histamine Antagonists ; Humans ; Hypereosinophilic Syndrome* ; Hyperplasia ; Leukemia ; Leukocytosis ; Liver ; Lymphoma ; Necrosis ; Opportunistic Infections ; Radionuclide Imaging ; Spleen ; Ultrasonography

The hyperosinophilic syndrome (HES) commonly involves liver and spleen but only a few literature has reported the imaging features. In this article, we present the imaging features of the liver and spleen in HES patients together with clinical and laboratory features. This study included 5 HES patients with hepatic involvement. Extensive laboratory tests including multiple hematologic, serologic, parasitologic, and immunologic examinations were performed. Imaging studies included CT, ultrasound (US) of upper abdomen and hepatosplenic scintigraphy. All patients were periodically examined by laboratory and imaging studies for 4 to 24 months. The common clinical presentations were weakness, mild fever, and dry cough. All patients revealed leukocytosis with eosinophilia of 40 to 80% and benign eosnophilic hyperplasia of the bone marrow. The percutaneous biopsy of the hepatic focal lesions performed in 2 patients showed numerous benign eosinophilic infiltrates and one of them revealed combined centrilobular necrosis of hepatocytes. All cases revealed hepatomegaly with multiple focal lesions on at least one of CT, US, or scintigraphy. These findings completely disappeared in 2 To 6 months following medication of corticosteroid or antihistamines. The HES involved the liver and CT, US, or scintigraphy. These findings completelydisappeared in 2 to 6 months following medication of corticosteroid or antihistamines. The HES involved the liver and CT, US, or scintigraphic studies showed hepatic multifocal lesions with hepatomegaly. Differential diagnoses of these findings should include metastatic disease, lymphoma, leukemia. candidiasis or other opportunistic infections.
Abdomen ; Biopsy ; Bone Marrow ; Candidiasis ; Cough ; Diagnosis, Differential ; Eosinophilia ; Eosinophils ; Fever ; Hepatocytes ; Hepatomegaly ; Histamine Antagonists ; Humans ; Hypereosinophilic Syndrome* ; Hyperplasia ; Leukemia ; Leukocytosis ; Liver ; Lymphoma ; Necrosis ; Opportunistic Infections ; Radionuclide Imaging ; Spleen ; Ultrasonography

No abstract available.
Anemia, Hypoplastic, Congenital*

INTRODUCTION: Critical thinking involves identifying problem(s), assessing resources, and generating possible solutions and allows clinical nurses to decide which solution is the most reasonable under the given circumstances, taking into consideration the "what ifs" and how they will affect the end result. This research was conducted to further understanding and identification of subjective factors in critical thinking in clinical nurses. METHODS: The research design was a Q-Methodological Approach. Q-population was formulated from a non-structured questionnaire and interviews from 17 experienced clinical nurses. Thirty selected Q-statements were sorted by 30 experienced clinical nurses. RESULTS: Four factors for critical thinking were identified: (1) Deductive reasoning based on causal relation, (2) Construction of an effective model based on patients' responses, (3) Formulating categories based on priorities for effective interventions, and (4) Judging validity of the situational significance on clinical performances. CONCLUSION: Critical thinking is an attitude and reasoning process. From this study, the frame of reference for clinical nurses in formulating critical thinking within the context of clinical settings is identified and indicates the way nurses utilize thinking skills when they care for patients and areas that need further exploration as nurses and faculty develop education systems to advance clinical performance competency.
Humans ; Surveys and Questionnaires ; Research Design ; Thinking

To identify osteoporosis and examine the relationship between health behavior and the self-efficacy of middle-aged women, a descriptive survey was conducted. The subjects were 465 healthy female residents of Kyunggido, Korea, who underwent ultrasound measurement and a health examination at the Kangmeung-Ci Health Center between July and August 2000. They were 40 to 60 years old, with a mean age of 46.7 years. The subjects completed a self- reported questionnaire that consisted of seven items concerning health behavior and twelve items concerning self-efficacy related to osteoporosis. Bone density was evaluated from ultrasound measurements of the right heel. All the data were analyzed using the program SAS-PC. The study found that the mean T score related to bone density was -1.30, and ranged from -3.52 to 3.06. Based on the T score, 74.8% of the subjects were normal, 12.9% had osteopenia, and 12.3% had osteoporosis. The mean osteoporosis self-efficacy score was 41.17 and ranged from 12 to 60. Osteoporosis self-efficacy differed significantly with health behavior related to health supplementary food (t=5.63, p=.018), exercise (t=6.65, p=.010), alcohol drinking(t=10.80, p=.001), and smoking (t=10.23, p=.001). A community-based health promotion program should be developed to prevent osteoporosis in middle-aged women.
Bone Density* ; Bone Diseases, Metabolic ; Female ; Gyeonggi-do ; Health Behavior ; Health Promotion ; Heel ; Humans ; Korea ; Middle Aged ; Osteoporosis ; Surveys and Questionnaires ; Smoke ; Smoking ; Ultrasonography

Technological advances in video camera, high resolution monitors and optical systems have produced considerable process in endoscopic surgery. Recently we have experienced transthoracic endoscopic sympathectomy(TES) for the treatment of Buerger's disease of both hands in a 47 years old male healthy patient. For the TES, one lung ventilation is necessary to provide adequate surgical access, so this patient had general anesthesia with a disposable left sided Robertshaw double lumen endobronchial tube. The patient was monitored for arterial pressure, herat rate, ECG, pulse oximetry, end-tidal carbon dioxide concentration, peak inspired airway pressure and arterial blood gas analysis. Potenial intraoperative problems wese hypoxemia during one-lung anesthesia, hypotension and hypercarbia occurred by insufflation of carbon dioxide into the chest cavity. Our patient also developed moderate hypoxemia which was corrected by application of high frequency jet ventilation with low driving pressure during right sided operation, and increased significantly arterial carbon dioxide tension about 8-12 mmHg during one lung ansthesia. We reviewed our experience and discussed the anesthetic technique and perioperative problems encounterd in the patient undergoing transthoracic endoscopic sympathectomy for Buerger's disease.
Anesthesia* ; Anesthesia, General ; Anoxia ; Arterial Pressure ; Blood Gas Analysis ; Carbon Dioxide ; Electrocardiography ; Hand ; High-Frequency Jet Ventilation ; Humans ; Hypotension ; Insufflation ; Lung ; Male ; Middle Aged ; One-Lung Ventilation ; Optical Devices ; Oximetry ; Sympathectomy* ; Thorax ; Thromboangiitis Obliterans

PURPOSE: The purpose of this study was to investigate factors associated with the intention to quit smoking in community-dwelling elderly smokers. METHODS: From the database of the Fourth Korean National Health and Nutrition Examination Survey (KNHANES-IV), the researchers selected 448 elderly smokers over the age of 65. Data were analyzed with the chi2 test and multiple logistic regression using the SPSS/WIN 18.0 program. RESULTS: Of the respondents, 45.5% intended to quit. The factors associated with the intention to quit were relative youth, having limit of activity day living and having past attempts to quit. CONCLUSION: Population-based smoking cessation programs, especially those targeted at the elderly, should take these predictors into consideration in the design of interventions.
Adolescent ; Aged ; Surveys and Questionnaires ; Humans ; Intention ; Logistic Models ; Nutrition Surveys ; Smoke ; Smoking ; Smoking Cessation

Exercise testing with Thallium imaging is widely used for the noninvasive evaluation of patients suspected of having coronary artery disease. However, many patients referred for stress testing connot exercise adequately for either physical or psychological reasons, and as a result may have nondiagnostic or suboptimal test results. Intravenous dipyridamole in conjunction with Thallium imaging is as effective alternative method without exercise. But, myocardial imaging using the standard scintillation camera technique(planner view) is hampered by superposition of proximal & distal cardial walls and by the segmental nature of myocardial ischemia. For this reason, Single Photon Emission Computed Tomography(SPECT) reslut in high specificity & sensitivity rates for the detection of coronar artery disease compared with conventional technique. So we performed dipyridamole Th-201 myocardial scintigraphy on 25 subjects who have suspicious angina or myocardial infarction instead of exercise Th-201 myocardial scintigraphy, and compared SPECT view with conventional plannar view. The results obtained are as follows : 1) T1-201 scintigraphic findings in 17 patients with suspicious angina were as follows ; redistribution defect was seen in 4 cases in plannar view and 13 cases in SPECT view. 2) T1-201 scintigraphic findings in 8 patients with myocardial infarction were as follows ; in planner view, perfusion defect was seen in all cases and 1 cases of them, redistribution defect was accompained, and in SPECT view, perfusion defect was seen in all cases and 6 cases of them, redistribution defect was accompained. 3) During dipyridamole infusion, the mean systolic & diatolic pressure decreased from 133+/-22.7/86+/-13.5 to 121+/-23.9/78+/-13.1mmHg and the heart rate increased from 68+/-12.4 to 84+/-12.4beats/min. 4) Adverse effects of dipyridamole were noted in 14(56%) of the subjects, but in 12 of these, the symptoms were mild in severity and subsided spontanously. To summarize, Dipyridamole-201 myocardial imaging is a useful and test for coronary artery disease, and the new tomographic technique, SPECT view, is more useful than the conventional plannar view.
Arteries ; Coronary Artery Disease ; Dipyridamole* ; Exercise Test ; Gamma Cameras ; Heart Rate ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Myocardial Perfusion Imaging ; Perfusion Imaging* ; Perfusion* ; Sensitivity and Specificity ; Thallium* ; Tomography, Emission-Computed, Single-Photon*