We have observed that the companion shadow of the upper rib may be misinterpreted as a small pnemothorax or pleural plaque associated with asbestosis. To observe the radiographic characteristics of the normal companion shadow, we analyzed, on the posteroanterior(PA) chest radiographs, the companion shadow of 50 normal cases. Factors such as occurrence on each rib, the sharpness of the margin, the relative position to the rib, the shape and the thickness were observed. Also, we analyzed the displaced pleura of 4 pneumothorax cases to differentiate their frndings from the findings of normal companion shadows. On 50 normal chest radiographs, 192 compaion shadows were observed on the first to fourth ribs. In 173 of those shadows, the visceral margin of the companion shadow on the second rib simulated pneumothorax more closely than those on any othe rivs due to its apical location and thinness. In six of 50 normal cases, the companion shadow on the first or second rib showed an inw rdly convex lower margin, mimicking pleural plaque. The compaion shadow was suggested on the plain chest radiograph by the following characteristics imultiplicity(47/50), thicker than normal pleura(3/4), persistent on serial filma with the same shape and specific location(4/4).
Asbestosis ; Friends* ; Humans ; Pleura ; Pneumothorax ; Radiography, Thoracic ; Ribs* ; Thinness

A stellate ganglion block (SGB) is a widely used procedure in the treatment of chronic pain syndromes in the facial and cervicobrachial regions as well as in nonpainful conditions. The complications of a stellate ganglion block include intra-arterial or intracranial injection of local anesthetic, Horner's syndrome, phrenic nerve block, recurrent laryngeal nerve paralysis, brachial plexus block, and pneumothorax. Horner's syndrome after the performance of a stellate ganglion block is a valuable sign of a successful block, but contralateral or bilateral Horner's syndrome remains an unusual and poorly explained phenomenon. We experienced a case of a 56 year-old female patient who had developed ipsilateral and contralateral Horner's syndrome after a stellate ganglion block. The ipsilateral Horner's syndrome was resolved after several hours but the contralateral side lasted for a week.
Brachial Plexus ; Chronic Pain ; Female ; Horner Syndrome* ; Humans ; Middle Aged ; Paralysis ; Phrenic Nerve ; Pneumothorax ; Recurrent Laryngeal Nerve ; Stellate Ganglion*

PURPOSE: The purpose of this study was to identify the sleep patterns of nursing students using self-report questionnaire and physiologic measurement, to examine the factors influencing sleep patterns in based on Spielman's model. METHODS: Participants were 119 nursing students who were in the clinical practice period. Self-report questionnaires and actigraphy were used to collect the data. Data were analyzed using descriptive statistics, correlation and regression by the SPSS/WIN 21.0 programs. RESULTS: When sleep was measured by self-report questionnaire, 84 students (70.6%) showed poor sleep quality. The mean sleep efficiency was 82.6%, and 67 students(56.3%) showed low sleep efficiency (less than 85.0%). The factors affecting subjective sleep pattern measured by KMLSEQ were circadian sleep type (β=.28, ρ=.003) and alcohol (β=.20, ρ=.031). The factors affecting total sleep time were sedentary behavior (β=-.27, ρ=.003) and daytime sleepiness (β=-.33, ρ<.001). CONCLUSION: Many nursing students in their clinical practice period expressed sleep disturbance. Factors affecting the perceived sleep measured by the self-report questionnaire and objective sleep evaluated by physiologic measures were different. The evening type of students perceived poor sleep quality, however, sedentary life style and daytime sleepiness resulted in short sleep time. Therefore, more studies measuring the objective sleep characteristics are needed using subjective and objective characteristics.
Actigraphy ; Humans ; Life Style ; Nursing* ; Students, Nursing*

Purpose: To determine the incidence and the time to failure of repaired short external rotator muscles through aposterolateral approach in total hip arthroplasties; and to describe the correlation between failure of the repaired short external rotator muscles and the hip dislocation rate. Materials and Methods: Between January 2003 and October 2003, 51 patients (55 cases) were treated with primary, uncemented total hip arthroplasties. The average patient`s age was 51 years (33 men, 19 women). After the short external rotator muscles were repaired, two 26-gauge wires were stitched as a marker to the abductor tendons and short external rotator tendons. The distance between the two opposing reference points was less than 1.2 cm. The distance between the markers was determined on radiographs that were obtained 1 day, 2 weeks, and 3 months post-operatively. A distance of more than 2.5 cm, or an invisible one, indicated failure. Results: Of a total of 52 repaired short external rotator muscles, 45 (86.5%) failed. Twenty-five(48.1%) failed within the first day, 15 (28.8%) within 2 weeks, and 5 (9.6%) within 3 months post-operatively. Regardless of the time of failure of the repaired short external rotator muscles, postoperative hip dislocations did not occur. Conclusion: The repair of short external rotator muscles after total hip arthroplasties has a high failure rate and contributes little to the prevention of hip dislocations.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Hip ; Hip Dislocation ; Humans ; Incidence ; Male ; Muscles* ; Tendons

Inability to synthetize adequate amounts of IL-2 has been suggested to be the basis of defective T-cell function following anesthesia with the operation. The present study was designed to examine the effect of anesthesia and operation on host defence mechenism. serum soluble IL-2R(sIL-2R) levels and hemo-dynamic parameters were measured in 30 patients. Patients were divided into two groups (G: general anesthesia with isoflurane, E:epidural anesthesia with bupivacaine) according to the method of anesthesia. Venous blood samples were taken before anesthesia(T1), 10 mins after induction of anesthesia(T2), 10 mins after injection of bupivacaine in epidural anesthesia(T2), 1 hour after skin incision(T3), 30 mins after completion of operation(T4), and 24 hours after completion of operation(T5). Simultaneously arterial blood pressure and heart rate were measured. Six mililiter of perip-heral blood was obtained for sIL-2R studies in plain tubes. Serum concentration of sIL-2R was measured by human IL-2 receptor ELISA kit(Boehringer Mannheim Biochemica, Mannheim, Germany). Any significant change in IL-2R level was not seen in patients under general anesthesia with isoflurane and operation. Also any significant change in IL-2R level was not seen in patients who had an epidural anesthesia with bupivacaine and operation. The results suggest that suppression of T-lymphocyte function and decrease in lymphocyte counts induced by anesthesia and operation is not due to alteration of intracellular metabolism, but due to extracellular immune depressor. And general anesthesia operation with isoflurane as well as epidural anesthesia with bupivgcaine is safe and can be selected for immunosuppressive patients.
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General* ; Arterial Pressure ; Bupivacaine* ; Enzyme-Linked Immunosorbent Assay ; Heart Rate ; Humans ; Interleukin-2* ; Isoflurane* ; Lymphocyte Count ; Metabolism ; Receptors, Interleukin-2 ; Skin ; T-Lymphocytes

Variables affecting bone heath of growing children were analyzed among forty nine 10-12 year old elementary students in three rural regions of north west Chungnam area. Information on age of the parents, duration of breast feeding and birth weight were collected from the guardians of the participants and nutrient intake and diet quality were assessed by average of three-day food records of participants with the help of dietitians. Bone health status was measured by calceneal broadband ultrasound attenuation (BUA) using quantitative ultrasound (QUS). Results showed that anthropometic indexes and nutrient intake levels were not different between boys and girls. However, iron intake was significantly lower in girls than in boys. Girls after menarche showed lower intake levels for thiamin, riboflavin, pyridoxine and niacin than girls before menarche. z-scores of BMI were lower than -1 and higher than +1 showed shorter breast feeding period than others but the difference was statistically non-significant. Overall, the subjects did not consume enough s of calcium, vitamin C and folic acid. Zinc intake and BMI were the most significant factors affecting BUA by the results of backward elimination in multiple regression models. Phosphorous and beta-carotene intakes showed significant negative relation with BUA. This study showed that children living in the rural area of Chungnam need extra care to keep their health and nutrient intakes especially for the nutrients known to affect growth. Tailored nutrition education needs to be more focused on the improvement of bone health status of children.
Ascorbic Acid ; beta Carotene ; Birth Weight ; Breast Feeding ; Calcium ; Child ; Diet ; Female ; Folic Acid ; Humans ; Iron ; Menarche ; Niacin ; Nutritional Status ; Parents ; Pyridoxine ; Riboflavin ; Zinc

BACKGROUND: At the end of the‘Waste Drug Disposal Project’, collection and disposal of waste drugs remain a social issue. OBJECTIVE: This study aimed to provide suggestions to improve the drug waste management system in Korea by comparing domestic and overseas relevant programs. Methods: This is a comparative study between South Korea, Australia, Canada, France, and the US. These overseas countries were selected because they have been operating waste drug management programs continuously to date. Comparison was conducted by a pre-determined analysis frame including legal regulation, enforcement program and its performance. RESULTS: All selected countries except Australia had legal regulations on drug wastes. The US had the largest variety of drug waste disposal methods. Canada had recommended that pharmacies actively participate in drug waste withdrawal programs. France had the largest variety of methods to promote relevant programs, including window sticker, SNS, and app, as well as the highest level of awareness and participation. Australia had the lowest level of awareness and participation in pharmaceutical waste management programs. Pharmaceutical companies took responsibility of paying for these programs in the selected overseas countries. CONCLUSION Further efforts should be made to establish a clear guideline including the role of pharmaceutical companies, and to develop various methods for the public to be aware of appropriate ways of disposing drug wastes in Korea.

The epidural abscess, while rare, should be taken seriously, as it can result in permanent neurological complications. Fever, back pain, leukocytosis and elevation of Erythrocyte Sedimentation Rate (ESR) are major signs and symptoms of epidural abscesses. But clinical recognition of such abscesses may be very difficult because of nonspecific symptoms or signs as well as previous or underlying painful disorders. Few cases has been reported of epidural abscess and epidural fibrosis associated with back surgery or temporary epidural blocks. In these cases, however, fever, low back pain, sciatica and elevation of ESR were the major findings. Magnetic Resonance Imaging findings after Gadolinium- diethylenetriaminopenta-acetic acid (Gd-DTPA) enhancement show central low signal intensity and surrounding high signal intensity at the anterior epidural space between the 5th lumbar and 1st sacral vertebrae. We suspected an epidural abscess caused by epidural block, and so operated. But our operative finding was epidural fibrosis without abscess. Our final pathological diagnosis was epidural fibrosis.
Abscess ; Back Pain ; Blood Sedimentation ; Diagnosis* ; Epidural Abscess* ; Epidural Space ; Fever ; Fibrosis* ; Leukocytosis ; Low Back Pain ; Magnetic Resonance Imaging ; Sciatica ; Spine

BACKGROUND: Early detection of vascular change may improve prediction of subclinical stage of cardiovascular disease, allowing intervention to prevent overt vascular damage. High heart rate is known to increase cardiovascular morbidity and mortality rate in the general population and in individuals with cardiovascular disease. We aimed to investigate the association between resting heart rate (RHR) measured using electrocardiogram (ECG) and arterial stiffness measured using the cardio-ankle vascular index (CAVI) in men. METHODS: Data were collected from 5,629 men aged between 20 and 78 years who visited a single-site health promotion center. RHR was measured in a supine posture after resting for 10 minutes using an ECG. Arterial stiffness was measured using the CAVI. The cutoff value for high CAVI was ≥9.0. RESULTS: RHR was one of the major determinants of high CAVI after adjusting for age, waist circumference, mean arterial pressure, glycosylated hemoglobin level, triglyceride level, white blood cell count, and lifestyle factors. When RHR groups were defined according to the RHR quartiles, the odds ratio of group with RHR ≥70 bpm, for high CAVI was 3.62 (95% confidence interval [CI], 2.21–5.91) after adjusting for age and lifestyle factors. This association was not changed after adjusting for all other covariates (odds ratio, 2.39; 95% CI, 1.36–4.19). CONCLUSIONS: RHR measured using ECG is significantly associated with arterial stiffness in men not taking medications for hypertension, dyslipidemia, or diabetes. These findings suggest that RHR may be useful in assessing cardiovascular risk in men.
Arterial Pressure ; Arteriosclerosis ; Cardiovascular Diseases ; Dyslipidemias ; Electrocardiography ; Health Promotion ; Heart Rate ; Heart ; Hemoglobin A, Glycosylated ; Humans ; Hypertension ; Leukocyte Count ; Life Style ; Male ; Mortality ; Odds Ratio ; Posture ; Risk Assessment ; Triglycerides ; Vascular Stiffness ; Waist Circumference

The CYP11A1 gene encodes for the cholesterol side-chain cleavage enzyme (P450scc), which initiates steroid hormone biosynthesis. Defective P450scc activity results in severe glucocorticoid and mineralocorticoid deficiencies. We describe a case of P450scc deficiency due to a novel homozygous CYP11A1 variant inherited from the mother with a possibility of uniparental disomy (UPD). The patient was a female, had no family history of endocrine disease, and showed adrenal insufficiency at 13 days of age. Hormonal analysis with an adrenocorticotropic hormone stimulation test showed both glucocorticoid and mineralocorticoid deficiencies, presumed to be a defect of the early stage of steroidogenesis. Exome sequencing reported a novel homozygous frameshift variant of CYP11A1 (c.284_285del, p.Asn95Serfs*10), which was inherited from the mother.Additionally, homozygosity in 15q22.31q26.2, which included CYP11A1, was identified using a chromosomal microarray. It was suggested that the possibility of maternal UPD was involved as the cause of a P450scc deficiency by unmasking the maternally derived affected allele. To our understanding, P450scc deficiency associated with UPD encompassing CYP11A1 had not been reported in Korea before. Genetic analysis can help diagnose rare causes of primary adrenal insufficiency, including P450scc deficiency.