PURPOSE: The purpose of this study was to identify relationships between quality of sleep, symptom cluster, depression, environmental disorder, and quality of life among hospitalized cancer patients. METHODS: The subjects were 114 patients who underwent chemotherapy for colon cancer, gastric cancer, gynecologic cancer and breast cancer. They were recruited from the cancer center of a university hospital. Data were collected from August 4th to 30th, 2011. The questionnaires included the Korean sleep scale A (quality of sleep), MDASI-K (symptom cluster), the environmental sleep disturbing scale, Zung's depression scale, and the Korean version of EORTC QLQ-C30. The collected data was analyzed by t-test, ANOVA, multiple regression analysis using the SPSS 19.0 program. RESULTS: Functional QOL was negatively associated with symptom QOL (r=-.798, p<.001). Symptom cluster, depression, & spouse (46.3%) were the most powerful predictors for functional QOL (46.3%) and symptom QOL (53.4%). CONCLUSION: It is evident that oncology nurses need to evaluate two dimensions of quality of life for cancer patients, for example, functional and symptom QOL. We recommend nurses develop specific protocols for relieving physical symptoms and alleviating depression, and furthermore test the effectiveness of them.
Breast Neoplasms ; Colonic Neoplasms ; Depression ; Humans ; Quality of Life ; Spouses ; Stomach Neoplasms ; Surveys and Questionnaires

Myotonic dystrophy is a multisystemic disorder inherited as an autosomal dominant trait. The characteristic clinical features include the presence of myotonia, atrophy of the muscles of the face and the sternocleidomastoids and numerous nonmusclar manifestations such as cataracts, frontal baldness, gonadal dysfunctions and cardiac abnormalities. We experienced one case of myotonic dystrophy with prolonged atrial flutter in 30-year-old male who was admitted because of palpitation. We present this case with reviewing literatures.
Adult ; Alopecia ; Atrial Flutter* ; Atrophy ; Cataract ; Gonads ; Humans ; Male ; Muscles ; Myotonia ; Myotonic Dystrophy*

BACKGROUND: Nosocomial urinary tract infection (UTI) is the most frequent nosocomial infection and could be prevented through the intensive nosocomial infection control (NIC) or restricting the use of indwelling urinary catheter. The efficiency of the intensive NIC to prevent UTI for the patients with indwelling urinary catheter was investigated. METHODS: Study population consisted of 296 patients with indwelling urinary catheter in the intensive care unit (lCU) who didn't have UTI on admission. The incidence rates of nosocomial UTI were compared between 146 patients being provided with ordinary NIC from March 15 to July 31, 1995 (control group) and 150 patients being provided with intensive NIC from January 16 to October 31, 1996 (NIC group). RESULTS: There was significant decrease in the incidence of nosocomial UTI in the NIC group (35 UTI among 150 patients, 23.8%) than in me control group (68 UTI among 146 patients, 46.6%) (P<0.01). But there were no differences in age distribution, sex, admission route to the ICU and underlying diagnoses between two groups. Interval between insertion of urinary catheter and development of UTI was significantly prolonged in the NIC group (10.0 +/- 3.5 days) than in the control group(7.6 +/- 3.9 days) (p < 0.01) despite there were no differences in the duration of urinary catheterization in two groups. The most common organism isolated from the urine of the patients was Candida tropicalis in both groups and the other organisms were in the order of Enterococcus faecium, Pseudomonas putida, Staphylococcus epidermidis in the control group and in the order of Staphylococcus aureus, Acinetobacter baumannii, Enterococcus faecalis in the NIC group. Four of five Staphylococcus aureus isolated in NIC group were MRSA. CONCLUSION: This study result confirms the efficiency of intensive NIC fur decrease in the incidence of nosocomial UTI in patients with indwelling urinary catheter. But the incidence of nosocomial UTI should be decreased further through the continuous emphasis on NIC and it seems to be necessary to study the effect of each component of NIC with proper control of the risk factors for the development of nosocomial UTI in the future.
Acinetobacter baumannii ; Age Distribution ; Candida tropicalis ; Cross Infection* ; Diagnosis ; Enterococcus faecalis ; Enterococcus faecium ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Methicillin-Resistant Staphylococcus aureus ; Pseudomonas putida ; Risk Factors ; Staphylococcus aureus ; Staphylococcus epidermidis ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract Infections* ; Urinary Tract*

BACKGROUND: Stunned myocardium may be mediated by intracellular Ca2+ overloading or oxygen derived-free radicals. Halothane and propofol have been shown to block Ca2+ channels. Propofol is also known to have antioxidant properties. The present study was aimed to investigate the effects of anesthetics on recovery of postischemic, reperfused myocardium in open-chest dogs. Incidence of ventricular arrhythmia upon ischemia and reperfusion was also determined. METHODS: Forty dogs were subjected to 15 min occlusion of left anterior descending coronary artery (LAD) followed by 3 hr reperfusion during halothane (n=10), fentanyl (n=12), or propofol plus fentanyl (n=11) anesthesia. Regional contractile function was assessed using percent systolic shortening (%SS), the preload recruitable stroke work slope (Mw), and peak systolic intramyocardial pressure (IMPs). Diastolic function was evaluated using time constant for isovolumic intramyocardial pressure decline of left ventricle (IMP-tau) and percent post-systolic shortening (%PSS). RESULTS: %SS in the halothane, fentanyl, and propofol-fentanyl groups was similar at 3 hours of reperfusion (58%, 60%, and 55% of baseline value, respectively). Moreover, Mw recovered to the baseline values in the early reperfusion period in all three groups. However, IMP-tau was significantly prolonged in the halothane group throughout the 3 hour reperfusion period, whereas it remained unchanged in the fentanyl and propofol-fentanyl groups. Coronary occlusion was associated with 9, 33, and 0% mortality rate due to ventricular fibrillation upon ischemia and reperfusion in the halothane, fentanyl, and propofol-fentanyl groups, respectively. CONCLUSION: These findings indicate that halothane, but not fentanyl and propofol- fentanyl, impairs myocardial relaxation, while recovery pattern of contractile function do not differ among three groups, and that halothane and propofol reduce reperfusion arrhythmia in the canine model of myocardial stunning.
Anesthesia* ; Anesthetics ; Animals ; Arrhythmias, Cardiac ; Coronary Occlusion ; Coronary Vessels ; Dogs* ; Fentanyl* ; Halothane* ; Heart Ventricles ; Incidence ; Ischemia ; Mortality ; Myocardial Stunning* ; Myocardium ; Oxygen ; Propofol ; Relaxation ; Reperfusion ; Stroke ; Ventricular Fibrillation

Objective: The present study aimed to assess the relationship between incidental abnormalities on thoracic computed tomography (CT) and mortality in a general screening population using a long-term follow-up analysis. Materials and Methods: We retrospectively collected the medical records and CT images of 840 participants (mean age ± standard deviation [SD], 58.5 ± 6.7 years; 564 male) who underwent thoracic CT at a single health promotion center between 2007 and 2010. Two thoracic radiologists independently reviewed all CT images and evaluated any incidental abnormalities (interstitial lung abnormality [ILA], emphysema, coronary artery calcification [CAC], aortic valve [AV] calcification, and pulmonary nodules). Kaplan–Meier analysis with log-rank and z-tests was performed to assess the relationship between incidental CT abnormalities and all-cause mortality in the subsequent follow-up. Cox proportional hazards regression was performed to further identify risk factors of all-cause mortality among the incidental CT abnormalities and clinical factors. Results: Among the 840 participants, 55 (6%), 171 (20%), 288 (34%), 396 (47%), and 97 (11%) had findings of ILA, emphysema, CAC, pulmonary nodule, and AV calcification, respectively, on initial CT. The participants were followed up for a mean period ± SD of 10.9 ± 1.4 years. All incidental CT abnormalities were associated with all-cause mortality in univariable analysis (p < 0.05). However, multivariable analysis further revealed fibrotic ILA as an independent risk factor for all-cause mortality (hazard ratio, 2.52 [95% confidence interval, 1.02–6.22], p = 0.046). ILA were also identified as an independent risk factor for lung cancer or respiratory disease-related deaths. Conclusion Incidental abnormalities on screening thoracic CT were associated with increased mortality during the long-term follow-up. Among incidental CT abnormalities, fibrotic ILA were independently associated with increased mortality. Appropriate management and surveillance may be required for patients with fibrotic ILA on thoracic CT obtained for general screening purposes.

It was reported that the etiologies of recurrent spontaneous abortion are immunologic factors, endocrinologic problems, anatomical abnormalities, genetic abnormalities, infection, and unexplained factors. Among those etiologic factors, genetic abnormalities occur in about 5% of the couples who experience recurrent spontaneous abortions, and most common parental chromosomal abnormality contributing to recurrent abortion is balanced translocation. The advent of in vitro fertilization (IVF), the development of skills associated with the handling of human embryo, and an explosion of knowledge in molecular biology have opened the possibility of early diagnosis of genetic disease in preimplantation embryos. Therefore preimplantation genetic diagnosis (PGD) is indicated for couples, infertile or not, at risk of transmitting a genetic disease. A case of successful pregnancy and term delivery by PGD using fluorescence in situ hybridization (FISH) technique in patient with recurrent spontaneous abortion due to balanced translocation is presented with brief review of literatures.
Abortion, Habitual ; Abortion, Spontaneous* ; Blastocyst ; Chromosome Aberrations ; Early Diagnosis ; Embryonic Structures ; Explosions ; Family Characteristics ; Female ; Fertilization in Vitro ; Fluorescence ; Humans ; Immunologic Factors ; In Situ Hybridization ; Molecular Biology ; Parents ; Pregnancy* ; Preimplantation Diagnosis* ; Prostaglandins D

PURPOSE: Studies on cytomegalovirus (CMV) infections in immunocompetent children are lacking, and minimal information is available in the medical literature on hepatic manifestations and complications of CMV. The aims of this study were to evaluate the clinical characteristics, laboratory data, and prognosis of children with CMV hepatitis, and to investigate its prevalence at a single medical center in Korea over a 10-year period. METHODS: One hundred thirty-two children diagnosed with CMV infection based on specific markers (anti-CMV IgM, CMV polymerase chain reaction in blood and urine, or CMV culture of urine) were included in the study. Clinical and biochemical characteristics, immunological markers, and outcomes of hepatic CMV infection were determined. RESULTS: The median age of patients (n=132) was 8.5 months (range, 14 days–11.3 years). Peak total bilirubin and alanine aminotransferase levels in serum ranged from 0.11–21.97 mg/dL, and 5–1,517 IU/L, respectively. Alanine aminotransferase remained elevated from 2–48 weeks. Jaundice was the most common clinical feature of hepatic CMV infection during infancy. The hematologic findings revealed anemia, leukocytosis, and monocytosis in CMV-infected patients. All participants recovered without administration of ganciclovir. CONCLUSION: In children with CMV hepatitis, fever was the most common symptom at presentation, and jaundice was the most common clinical feature of hepatic CMV infection in infants younger than 3 months of age. Hepatic CMV infection in immunocompetent children is often a self-limited illness that does not require antiviral therapy, as most patients in this study had favorable outcomes.
Alanine Transaminase ; Anemia ; Bilirubin ; Child* ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Epidemiology ; Fever ; Ganciclovir ; Hepatitis ; Humans ; Immunoglobulin M ; Infant ; Jaundice ; Korea* ; Leukocytosis ; Polymerase Chain Reaction ; Prevalence ; Prognosis*

BACKGROUND: Myocardial calcium overload during reperfusion may contribute to myocardial stunning. The protective effect of nicardipine against post-ischemic myocardial dysfunction was investigated. METHODS: Twenty-two halothane-anesthetized dogs were subjected to 15 minutes of left anterior descending coronary artery (LAD) occlusion and subsequent 3 hour reperfusion. One group of dogs (n=11) received nicardipine (1 microgram/kg/min) and another group (n=11) received saline (0.5 ml/kg/h) through intracoronary catheter for 1 hour beginning 15 minutes before LAD occlusion. Systolic shortening (%SS) and preload recruitable stroke work slope (Mw), as an index of regional myocardial contractility, and IMP-tau (time constant of myocardial relaxation based on intramyocardial pressure (IMP)) and post-systolic shortening (%PSS), as an index of regional diastolic function, were evaluated. LAD blood flow was measured by Doppler flowmeters as well. RESULTS: Regional systolic as well as diastolic functions during acute myocardial ischemia were similar between the two groups. However, Mw recovered to the baseline value with the onset of reperfusion in the nicardipine group but was significantly decreased throughout the reperfusion period in the controls. After 3 hours of reperfusion, the nicardipine group had recovered 67% of %SS, compared with 20% of the control group. IMP-tau was restored to the baseline value by 60 min of reperfusion in the control group but was significantly prolonged in the nicardipine group throughout the reperfusion period. CONCLUSIONS: Intracoronary nicardipine enhances the recovery of regional contractile function but prolongs myocardial relaxation in the canine model of myocardial stunning.
Animals ; Calcium ; Catheters ; Coronary Vessels ; Dogs* ; Flowmeters ; Myocardial Ischemia ; Myocardial Stunning* ; Nicardipine* ; Relaxation ; Reperfusion ; Stroke

Mitral ring motion and indices of left ventricular diastolic filling were measured by M-mode and Doppler echocardiography in apical 4 chamber view in 11 dilated cardiomyopathy patients and 9 normal subjects without clinical evidence of heart disease. The mean age of patients was 52 years and average heart rate was 76 beats/min. The parameters of mitral annulus motion include earley relaxation amplitude(ER), late atrial contraction amplitude(AC) and A2-peak excursion(A2-PE). Transmitral flow velocity parameters include peak flow velocity of early diastolic flow velocity(PFVE), peak flow velocity of late atrial contraction(PFVA), the ratio between early and late peak flow velocity(PFVE/PFVA), Acceleration rate of early diastolic peak flow(AR), deceleration rate of early diastolic peak flow(DR), time velocity integral of early diastolic flow velocity(TVIE), time velocity integral of late atrial contraction flow velocity(TVIA) and ratio between early diastolic and late atrial flow velocity integral(TVIE/TVIA). In patients with dilated cardiomyopathy, ER(4.5+/-2.3mm) and AC(2.3+/-1.6mm) were significantly decreased than normal(10.7+/-2.6mm, 6.6+/-1.6mm, p<0.01, p<0.01, respectively), whereas ER/AC(1.7+/-0.7) was not significantly different than normal subjects(1.6+/-0.5). A2-PE(100+/-80 msec) was significantly delayed in dilated cardiomyopathy patients than normal subjects(35+/-25 msec, p<0.01). In analysis of transmitral flow velocities, PFVE, PFVA and PFVE/PFVA, etc were not significantly different compared to normal subjects in patients with dilated cardiomyopathy. Mitral ring motion amplitude was decreased and A2-peak excursion time interval(A2-PE) was delayed in patients with dilated cardiomyopathy, but transmitral flow velocities were not significantly different from normal subjects in patients with dilated cardiomyopathy. These results reflect the facts that early diastolic relaxation amplitude is decreased by the change of compliance of LV and late atrial contractin amplitude is decreased by decrease of atrial contractility and increased stiffness of LA and LV. Despite of decreased mitral ring motion, transmitral flow velocity is not significantly different compared to normal subjects in patients with dilated cardiomyopathy. From these evidences, not only transmitral flow velocity affected by multiple factors but also mitral ring motion affected by LA and LV function are considered in assessment of LV diastolic dysfuction.
Acceleration ; Blood Flow Velocity* ; Cardiomyopathy, Dilated* ; Compliance ; Deceleration ; Echocardiography, Doppler ; Heart Diseases ; Heart Rate ; Humans ; Relaxation

OBJECTIVES: The aims of this study are 1) to determine if GAST is a better indicator in predicting ovarian response to COH compared with patient's age or basal FSH level and 2) to evaluate its role in detecting abnormal ovarian response. DESIGN : Prospective study in 118 patients undergoing IVF-ET using GnRH-a short protocol during May-September 1995. MATERIALS AND METHODS: After blood sampling for basal FSH and estradiol (E2) on cycle day two, 0.5 ml (0.525 mg) GnRH agonist (Suprefact, Hoechst) was injected subcutaneously. Serum E2 was measured 24 hours later. Initial E2 difference (deltaE2) was defined as the change in E2 on day 3 over the baseline day 2 value. Sixteen patients with ovarian cyst or single ovary or incorrect blood collection time were excluded from the analysis. The patients were divided into three groups by deltaE2; group A (n=30):deltaE2<40 pg/ml, group B (n=52): 40 pg/ml< or =deltaE2<100 pg/ml, group C (n=20): deltaE2< or =100 pg/ml. COH was done by GnRH agonist/HMG/hCG and IVF-EF was followed. Ratio of E2 on day of hCG injection over the number of ampules of gonadotropins used (E2hCGday/Amp) was regarded as ovarian responsiveness. Poor ovarian response and overstimulation were defined as E2 hCGday less than 600 pg/ml and greater than 5000 pg/ml, respectively. RESULTS: Mean age (+/-SEM) in group A, B and C were 33.7+/-0.8*, 31.5 +/-0.6 and 30.6+/-0.5*, respectively (*: p<0.05). Mean basal FSH level of group A (11.1+/-1.1 mIU/ml) was significantly higher than those of B (7.4+/- 0.2 mIU/ml) and C (6.8+/-0.4 mIU/ml) 0<0.001). Mean E2hCGday of group A was significantly lower than those of group B or C, i.e., 1402.1+/-187.7 pg/ml, 3153.2+/- 240.0 pg/ml, 4078.8+/-306.4 pg/ml respectively (p<0.0001). The number of ampules of gonadotropins used in group A was significantly greater than those in group B or C: 38.6+/-2.3, 24.2+/-1.1 and 18.5+/-1.0 (p<0.0001). The number of oocytes retrieved in group A was significantly smaller than those in group B or C: 6.4+/-1.1, 15.5+/-1.1 and 18.6+/-1.6, respectively (p<0.0001). By stepwise multiple regression, only deltaE2 showed a significant correlation (r=0.68, p<0.0001) with E2HCGday/Amp, while age or basal FSH level were not significant. Likewise, only deltaE2 correlated significantly with the number of oocytes retrieved (r=0.57, p<0.001). All four patients whose COH was canceled due to poor ovarian response belonged to group A only (Fisher's exact test, p<0.01). Whereas none of 30 patients in group A (0%) had overstimulation, 14 patients among 72 patients (19.4%) in group B and C had overstimulation (Fisher's exact test, p<0.01). CONCLUSIONS: These data suggest that initial E2 difference after GAST may be a better prognostic indicator of ovarian response to COH than age or basal FSH level. Since initial E2 difference demonstrates significant association with abnormal ovarian response such as poor ovarian response necessitating cycle cancellation or overstimulation, GAST may be helpful in monitoring and consultation of patients during COH in IVF-ET cycle.
Estradiol ; Female ; Gonadotropin-Releasing Hormone* ; Gonadotropins ; Humans ; Oocytes ; Ovarian Cysts ; Ovary ; Ovulation Induction* ; Prospective Studies