BACKGROUND: Home ventilation can decrease hospital-acquired infection, increase physical activity, improve nutritional status, enhance quality of life, and reduce medical costs. The number of patient using home ventilators has been increasing, particularly in Europe and United States. Although the number of patients with home ventilation has been increasing in Korea, the current status of these patients is not well known. This study was undertaken to obtain basic information upon these patients in additon to evaluating any problems related to patients' home care in our country. METHODS: A register of 92 patients with home ventilators in Seoul and Kyunggi province were obtained from commercial ventilator supply companies. The patients were contacted by phone and 29 of them accepted our visit. Information concerning education about home care before discharge, equipment cost, and problems related to home care were documented. The mode and preset variables of the home ventilator were checked; tidal volume (TV), peak airway pressure, and oxygen saturation were measured. RESULTS: There were 26 males (90%) and their mean age was 48.0(±20.1 years. The underlying diseases were: 21 neuromuscular disorders, 2 spinal cord injuries, 6 chronic lung diseases. Among the caregivers, spouses (n=14) predominated. Education for home care before discharge was performed primarily by intensive care unit nurses and the education for ventilator management by commercial companies. Twenty-five of the 29 patients had tracheostomies. Volume targeted type (VTT;n=20, 69%) was more frequently used than the pressure targeted type(PTT). Twenty-three of the 29 patients purchased a ventilator privately, which cost 7,450,000(±3,290,000) won for a PTT, and 14,280,000(±3,130,000) won for a VTT. Total cost for the equipment was 11,430,000(±634,000) won. The average cost required for home care per month was 1,120,000(±1,360,000) won. CONCLUSION: The commonest underlying disease of the patients was neuromuscular disease. The VTT ventilator was primarily used with tracheostomy. Patients and their families considered the financial difficulties associated with purchasing and maintaining equipment for home care an urgent problem. Some patients were aided by a visiting nurse, however most patients were neglected and left without professional medical supervision.
Caregivers ; Education ; Europe ; Gyeonggi-do* ; Home Care Services ; Humans ; Intensive Care Units ; Korea ; Lung Diseases ; Male ; Motor Activity ; Neuromuscular Diseases ; Nurses, Community Health ; Nutritional Status ; Organization and Administration ; Oxygen ; Quality of Life ; Seoul* ; Spinal Cord Injuries ; Spouses ; Tidal Volume ; Tracheostomy ; United States ; Ventilation ; Ventilators, Mechanical*

BACKGROUND: Following several decades of decline, the incidence of tuberculosis has recently begun to increase in many countries and the control of this disease has been impeded by the emergence of multi-drug resistant tuberculosis (MDR-TB). The development of rapid diagnostic methods and effective new drugs are needed to control MDR-TB. One of the new drugs for MDR-TB is rifabutin (RBU) which has been known to be effective in some patients with MDR-TB. A few reports showed that some types of mutaitions of the rpoB gene, which were known to be present in 96-98% of rifampicin-resistant M. tuberculosis, were associated with the rifampicin-resistant but RBU-susceptible phenotype. This study was performed to investigate the correlation between RBU susceptibility and the patterns of rpoB gene mutations in Korean MDR-TB. METHODS: Sixty-five clinical isolates of multi-drug resistant Mycobacterium tuberculosis, gathered from patients two visited the Asan Medical Center from July 1997 to June 1999, were investigated. Clinical responses to rifabutin-containing regimen were evaluated. An RBU susceptibility test and sequencing analysis of rpoB gene were performed, and the result were analyzed to confirm which mutations correlated with RBU-susceptible MDR-TB. RESULTS: Fifty-three of 56 (95%) clinical isolates of MDR-TB had 60 mutations of the rpoB gene. The most frequent mutations were found at codon 531 (43%), and two mutations were combined in seven clinical isolates. Five of 53 (10%) clinical isolates showed the RBU-susceptible phenotype, and in them the characteristic patterns of point mutations were found at codon 509, 516, and 526. CONCLUSION: The frequency and pattern of mutations of the rpoB gene of Korean MDR-Tb isolates were similar to those in western countries, where the prevalence of tuberculosis is low, but some show RBU-susceptible phenotypes. RBU-susceptible MDR-TB isolates showed the characteristic pattern of mutations of the rpoB gene which could be used to rapidly diagnose RBU susceptibility.
Chungcheongnam-do ; Codon ; Humans ; Incidence ; Mycobacterium tuberculosis* ; Mycobacterium* ; Phenotype ; Point Mutation ; Prevalence ; Rifabutin* ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

PURPOSE: The purpose of this study was to propose finite element (FE) modeling methods for predicting stress distributions on teeth and mandible under chewing action. MATERIALS AND METHODS: For FE model generation, CT images of skull were translated into 3D FE models, and static analysis was performed considering linear material behaviors and nonlinear geometrical effect. To find out proper boundary and loading conditions, parametric studies were performed with various areas and directions of restraints and loading. The loading directions are prescribed to be same as direction of masseter muscle, which was referred from anatomy chart and CT image. From the analysis, strain and stress distributions of teeth and mandible were obtained and compared with experimental data for model validation. RESULTS: As a result of FE analysis, the optimized boundary condition was chosen such that 8 teeth were fixed in all directions and condyloid process was fixed in all directions except for forward and backward directions. Also, fixing a part of mandible in a lateral direction, where medial pterygoid muscle was attached, gave the more proper analytical results. Loading was prescribed in a same direction as masseter muscle. The tendency of strain distributions between the teeth predicted from the proposed model were compared with experimental results and showed good agreements. CONCLUSION: This study proposes cost efficient FE modeling method for predicting stress distributions on teeth and mandible under chewing action. The proposed modeling method is validated with experimental data and can further be used to evaluate structural safety of dental prosthesis.
Dental Prosthesis ; Finite Element Analysis ; Mandible ; Masseter Muscle ; Mastication ; Pterygoid Muscles ; Skull ; Sprains and Strains ; Tooth

BACKGROUND: Pressure rise time (PRT) is the time in which the ventilator aclieves the set airway pressure in pressure-targeted modes, such as pressure control ventilation (PCV). With varying PRT, in principle, the peak inspiratory flow rate of the ventilator also varies. And if PRT is set to a shorter duration, the effective duration of target pressure level would be prolonged. which in turn would increase inspiratory tidal volume(Vti) and mean airway pressure(Pmean). We also postulated that the increase in Vti with shortening of PRT may relate inversely to the patients' basal airway resistance. METHODS: In 13paralyzed patients on PCV(pressure control 18±9.5cm H2, FIO2 0.6±0.3, PEEP 5±3cm H2O, f20/min, I : E, 1 : 2) with Servo 300(Siemens-Elema, Solna, Sweden)from various causes of respiratory failure, PRT of 10%, 5% and 0% were randomly applied. At 30min of each PRT trial, peak inspiratory flow (PIF, L/sec), Vti(ml), Pmean(cm H2O) and ABGA were determined. RESULTS: At PRT 10, 5% and 0%, PIF were 01.69±0.13, 0.77±0.19, 0.83±0.22, respectively(p<0.001). Vti were 425±94, 439±101, 456±106, respectively(p<0.001), and Pmean were 11.2±3.7, 12.0±3.7, 12.5±3.8, respectively(p<0.001). pH were 7.40±0.08, 7.40 ±0.92, 7.41±0.96, respectively (p=0.004) ; PaCO2 (mm Hg) were 47.4±15.8, 47.2±15.7, 44.6±16.2, respectively (p=0.004) ; PAO2 - PaO2 (mm Hg) were 220±98, 224±95, 227±94, respectively(p=0.004) ; and Vd/Vt as determined by (PaCO2 - P CO2/PaCO2 were 0.67±0.07, 0.67±0.08, 0.66 ±0.08, respectively(p=0.007). The correlation between airway resistance and change of Vti from PRT 10% to 0% were r=-0.243(0.498). CONCLUSION: Shortening of pressure rise time during PCV was associated with associated with increased tidal volume, increased mean airway pressure and lower PaCO2.
Airway Resistance ; Humans ; Hydrogen-Ion Concentration ; Respiratory Insufficiency ; Tidal Volume* ; Ventilation* ; Ventilators, Mechanical

This erratum is being published to correct the printing error on page 517 of the article. Corrections for Fig. 1 and main text in page 519 are needed. The authors apologize for any inconvenience that this may have caused.

BACKGROUND: To this date, efforts to develop effective methods for the education of diabetic patients have been limited. The important goal of self-management and weight control for diabetic treatment can not be attained without long and intensive period of education. This study was undertaken to assess the effectiveness of an intensive educational program, of behavior and diet control, which was carried out on subjects with type 2 diabetes, on an out-patient basis. We compared the effectiveness of an intensive education programme with that of a conventional education programme for the self-management of type 2 diabetic patients. METHODS: Subjects with type 2 diabetes were randomly selected, and allocated to one of two groups. One group received a conventional education programme of self-management(the CE group), and the second group received an intensive education programmes for three months, after which the effectiveness of the programmes were evaluated. RESULTS: 1) The levels of fasting blood sugar(FBS), postprandial 2 hour blood sugar(PP2h) and HbA1c were significantly lowered in both groups following the intervention(p<0.05). In the IE group, the FBS declined from 12.4nmol/L to 7.7nmol/L, PP2h declined from 20.3nmol/L to 10.9nmol/L, and the HbA1c showed a similar decline from 9.4 to 7.0% after intervention(p<0.05). In the CE group, the FBS declined from 10.9 to 9.4nmol/l, the PP2h decreased from 17.1 to 14.6 nmol/l, and the HbA1c also decreased from 8.5 to 7.3% after intervention(p<0.05). The decrease in the FBS and HbA1c following the educational intervention was more pronounced in the IE group than the CE group (p<0.05). 2) The effectiveness of the education programmes in promoting appropriate dietary behavior in the diabetic subjects was assessed by a scoring system in three parts: a regularity score, a balance score and an attitude score. From a comparative study of the three scores, the patients attitudes were observed to be much improved in both the groups following the intervention compared to before the programmes, but the balance and total scores were significantly higher in the IE group than the CE group(p<0.05). CONCLUSION: We can conclude that the intensive diabetic education programme is more effective than a conventional programme, not only in improving the patients' levels of glucose, HbAlc, and dietary score, but also the diabetic patients self-control abilities, promoting behavioral change, and prompting problem solving capabilities in respect to the everyday problems that they have to face throughout their lives.
Diet ; Education* ; Fasting ; Glucose ; Humans ; Outpatients ; Problem Solving ; Self Care

A glycogen storage disease(GSD) type I is a metabolic disease caused by a deficiency in one of the components of the glucose-6-phosphatase(G-6-Pase) system. This disorder results in hypoglycemia, hepatomegaly, lactic acidemia, hyperlipidemia, and hyperuricemia. Common long(-)term complications include growth retardation, gout, hepatic adenomas, osteoporosis and renal disease. However the cardiovascular system is rarely involved, and only six cases of pulmonary hypertension associated with GSD I have been reported in the literature. We experienced a case of pulmonary hypertension with type I GSD. A 31-year-old man, who had discovered type I GSD and received portocaval shunt operation 22 years ago, was admitted to the hospital with the chief complaint of dyspnea. Echocardiographic examination and cardiac catheterization revealed severe pulmonary hypertension. Nitric oxide and oral prostacycline derivative(beraprost) were tried without acute favorable response. After one year with beraprost, dyspnea, exercise capacity and hemodynamic parameters were improved. We report this case with a review of the literature.
Adenoma ; Adult ; Cardiac Catheterization ; Cardiac Catheters ; Cardiovascular System ; Dyspnea ; Echocardiography ; Epoprostenol ; Glycogen Storage Disease* ; Glycogen* ; Gout ; Hemodynamics ; Hepatomegaly ; Humans ; Hyperlipidemias ; Hypertension, Pulmonary* ; Hyperuricemia ; Hypoglycemia ; Metabolic Diseases ; Nitric Oxide ; Osteoporosis

We report three patients with pulmonary hypertension in Takayasu's arteritis, who showed long-term favorable response, clinically and hemodynamically, to the nitric oxide donor, molsidomine. In these patients, the inhaled nitric oxide was effective in reducing pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) as was shown in the acute vasodilator response test using the invasive hemodynamic monitoring. Molsidomine (single oral dose of 4 mg) was also effective in reducing PAP and PVR in the acute test, but nifedipine was not. With 4 mg of molsidomine three times daily, their dyspnea, exercise capacity and hemodynamic parameters were improved. These favorable responses have lasted during the 1st and 3rd month follow-up in all patients.
Dyspnea ; Follow-Up Studies ; Hemodynamics ; Humans ; Hypertension, Pulmonary* ; Molsidomine* ; Nifedipine ; Nitric Oxide* ; Pulmonary Artery ; Takayasu Arteritis* ; Tissue Donors ; Vascular Resistance

BACKGROUND: Respiratory care for patients in intensive care units(ICUs) has been performed mainly by nurses in Korea. However, the current status of respiratory care i the Korea ICUs is not well known. Respiratory care and the methods of delivery in ICUs were surveyed. METHOD: A confidential questionnaire was distributed to the head nurses working the ICUs at 117 hospitals in Korea. One hundred hospitals returned the questionnaires, for a response rate of 85%. The hospitals were divided into three groups : Main university hospitals(MUH), university associated hospitals(UAH), and general hospitals(GH) RESULT: Eighteen units of 66 units in MUH and 35 units of 58 units in GH were organized as a general ICUs. The percentage of ICUs with full-time doctors was 47.1%. The nurses usually delivered respiratory care spending from 1 to 4 h during their 8 h of working time. Although the respondents felt that respiratory care should be delivered by trained respiratory therapists, these therapists were not found at the hospitals. Most of the units performed percussion, tracheal suctioning, and positional changes. However, vibration and IPPB were less frequently performed in GH. Among oxygen supply apparatus, venturi mask and T-piece were not frequently used in GH. GH applied a noninvasive ventilator mode less frequently than MUH and UAH. The percentage of Swan-Ganz catheter monitoring was only 21.4% in GH. CONCLUSION: Respiratory care for patients in the Korean ICUs was provided by nurses on the whole. In addition, there were many differences in the level of respiratory care according to the type of hospital. To overcome the current problems revealed, an effective in-hospital training program for the development of full-time respiratory care therapists should be established urgently in Korea.
Catheters ; Data Collection ; Education ; Humans ; Intensive Care Units* ; Intensive Care* ; Intermittent Positive-Pressure Breathing ; Korea ; Masks ; Nursing, Supervisory ; Oxygen ; Percussion ; Suction ; Ventilators, Mechanical ; Vibration

The radiologically detectable pulmonary involvement of NHL at diagnosis is about 4%. The commonest intrathoracic manifestations of secondary pulmonary lymphoma are mediastinal or hilar lymph node enlargement. And the most frequent manifestations of pulmonary parenchymal lymphoma are lymphomatous nodules. But, when patients with newly diagnosed lymphoma exhibit rapidly progressive parenchymal lesions, an infection, such as pneumonia, is usually suspected. We present a report of a patient who developed rapidly progressive pulmonary involvement with T cell lymphoma, which was considered to be pneumonia bacause of high fever and rapidly progressive radiologic findings.
Diagnosis ; Fever* ; Humans ; Lung ; Lymph Nodes ; Lymphoma* ; Lymphoma, T-Cell ; Pneumonia ; T-Lymphocytes*