To evaluate the prognostic predictor and clinicopathologic characteristics of the gastrointestinal (GI) mesenchymal neoplasm, we examined 75 cases of GI mesenchymal tumors surgically resected during 8 years from 1983 to 1990. Various histological parameters referrable to the prognosis, including the Ag-NORs count, were analysed. Fifty cases were followed-up for 1 to 7 years. Sixteen out of these fifty cases died during this period. The location of tumor was the stomach in 33 cases, the small intestine in 31 cases and the large intestine in 11 cases, and the tumor size was variable from 2 to 35 cm in diameter. The GI mesenchymal neoplasm appeared as an extraluminal mass in 50 cases, an intramural mass in 17 cases, and an intraluminal mass in 8 cases. Each tumor was composed of spindle or epithelioid cells, the former cell type being more common than the latter (45 vs 30 cases). Mitotic count of the tumor showed the best correlationship with the survival of patients(p<0.05), although the tumor size and necrosis appeared to have some values. The Ag-NORs count was variable and was not significantly correlated with the patient's prognosis(p>0.05). These results indicate that the mitotic count is the most valuable pathological predictor for the prognosis in GI mesenchymal neoplasms.

This study examined effect of preceptorship on clinical education of senior nursing students of Y. University in Seoul. Quasi-experimental study design was used. Sixty students of pre-test and 80 of post-test participated in this study. Competency scores of the students before the clinical education(pre-competency scores) were compared with the competency scores after the clinical education(post-competency scores), and teacher evaluation scores between preceptors and clinical the data from students with preceptors(experimental group, N=22) and with clinical instructors(comparative group, N=58) were also examined. Study results indicated that the total post-competency scores were higher compared to the total pre-competency scores, and the difference was statistically significant. Among 7 sub-domains, differences were all statistically significant in 6 sub-domains except "self-esteem" domain. Competency scores of the students who had clinical education with had clinical education from clinical instructors. But the difference between those scores was not statistically significant. However, students gave higher evaluation scores to preceptors than clinical instructors. This study concluded that preceptorship did not influence much on clinical education at this time yet. However it is expected that when preceptors adjust their new roles and function them in expert education. This study recommended that for the preceptors to increase their motivation to teach students and to accept their roles, systemic rewards are needed.
Education* ; Humans ; Motivation ; Nursing* ; Preceptorship* ; Reward ; Seoul ; Students, Nursing*

BACKGROUND: To determine the natural progression of conservatively treated rotator cuff tears, we evaluated changes in radiologic and clinical parameters in patients whose recalcitrant tears were neglected after conservative treatment. METHODS: A total of 73 patients with recalcitrant rotator cuff tears in spite of conservative treatment were included in this study. We measured changes in tear size and in the extent of fatty infiltration of the rotator cuff by comparing the initial and final follow-up magnetic resonance imagings (MRIs). To determine factors influencing the change in tear size, we collected the medical history of patients taken at the time of initial admission. RESULTS: The average follow-up period was 20.1 months, and the average increase in tear size across this period was 6.2 mm. In terms of steroid injection, we found that the increases in tear size of the steroid injection group (p=0.049) and of the sub-group that had received more than three steroid injections (p=0.010) were significantly greater than that of the non-steroid injection group. CONCLUSIONS: We found that the increase in cuff tear size was on average 6.2 mm across the follow-up period, indicating that neglecting cuff tears may cause them to progress into more severe tears. We also observed that a history of steroid injection might be a possible risk factor for a worse prognosis of cuff tears. Therefore, we suggest that patients with rotator cuff tears and a history of steroid injection are recommended aggressive modes of treatment such as surgery.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Prognosis ; Retrospective Studies* ; Risk Factors ; Rotator Cuff* ; Tears*

BACKGROUND: In Korea before the enforcement of the medical reform in July 2000, it was generally difficult to analyze the conditions of prescriptions in hospitals and clinics. It was true that the circulation process of prescribed medicine was unclear and that there was no support between medical and pharmaceutical industries with the government. Also with the reality of high rate of pharmaceutical expenses among medical costs in Korea, it was necessary to enforce reform of medical and pharmaceutical industries and for our citizens to follow the new reform as well in order to prevent drug abuse and reduce medical costs. This research was to provide basis for future studies on prescription conditions and related factors through compared analysis of before and after the medical reform by analyzing university hospital prescriptions. METHODS: A comparison and analysis of patients, who visited a university hospital for medical treatment, was dpme. There were 23,974 patients in March 2000, and 22,550 patients in March 2001. During these periods 16,870, 12,919 prescriptions were each issued, respectively. RESULTS: There was a total of 46,524 outpatients with 29,789 prescription issued. There were 23,974 outpatients in March 2000 and 22,550 in March 2001 with 16,870 and 12,919 prescriptions, respectively. Among the outpatients, there were 20,769 men (44.6%) and 24,471 women (52.6%) with 13,527 and 16,209 prescriptions, respectively. In comparing the outpatients and prescription issued patients in March 2000 and in March 2001, both men and women showed decrease in the number of prescriptions (P <.001). Also in the ages between 0-15, 16-40 and 41-65, there was a clear evidence of decrease in the number of both outpatients and prescription issued patients (P<0.001). However in the age group of 65 and over there was an increase of 4,453 patients from 3,956 outpatients. The patient analysis in March 2000 and March 2001 excluding the outpatients in emergency, urology, dentistry and radiology shows a decrease in the number of patients in medical departments in general. Also except for the increase of prescription authorized patients in dentistry, urology and family health, it showed a decrease. In general, there was a decrease in the number of cases in the issuance of prescriptions excluding few item changes in the upper 1st to 10th medicine categories in prescribed frequencies. For prescribed medicine categories no vast difference existed. In total medicine categories, there was a decrease in injections from 24.5% to 12.3% and increase of oral medications from 64.5% to 73.8%. Also there was a significant decrease of prescriptions in injections for antibiotics and significant increase of prescription for anti-hypertensive agents such as Angiotensin Converting Enzyme inhibitors. CONCLUSION: This study involved before and after the reform of prescription conditions and obtained related factor information. The results may differ depending on the type of a hospital, patient distribution and local area, but has provided valuable basic research information which did not exist in previous university hospital unit. Hence in relation to the before and after the medical reform, future studies on diseases and on significant changes in elderly patient care, antibiotic usage and in categories of anti-hypertensive agents may be necessary.
Aged ; Angiotensin-Converting Enzyme Inhibitors ; Anti-Bacterial Agents ; Antihypertensive Agents ; Dentistry ; Drug Industry ; Emergencies ; Family Health ; Female ; Hospital Units ; Humans ; Korea ; Male ; Outpatients* ; Patient Care ; Prescriptions* ; Substance-Related Disorders ; Urology

BACKGROUND: With the rapid increase in elderly population arousing from development of medical technology and in standards of living, mental disorders as well as organic disorders according to aging constitute a serious social problem. This study aimed to find a factor related closely to cognitive impairment by analyzing the risk factors influencing cognitive impairment, which is one of the typical geriatric neuropsychiatric conditions. METHODS: This study was conducted using a questionnaire survey and history taking and physical examination was done in 200 elderly patients over sixty-five, who had visited either of the four universities hospitals in the Kyongin district from July 1997 to June 2002. A variety of factors being widely known to be related to cognitive impairment by was investigated using the existing comprehensive geriatric assessment. By using MMSE-K (Korea version of Mini- Mental State Examination), the relation between cognitive impairment and each variable was analyzed by using chi-square test and logistic regression analysis with SPSS 10.0k/PC statistical program. RESULTS: The number of males and females was 73 (36.5%) and 127 (63.5%), respectively, among the total number of 200 examinees. Males and females having symptoms of cognitive impairment was 25 (34.2%) and 49 (38.6%) among the total number of 74 (37%), respectively. Total mean point of MMSE-K was 24 5.4, 24 5.3 in males and 23.9 5.5 in females. According to the results of multi-variable quantities analysis, it was shown that the cognitive impairment had positive relation to age (P= 0.004), but negative relation to regular exercising (P= 0.016), instrumental activities of daily living (P=0.039) and social support (P=0.003). CONCLUSIONS: The factors having a close relation to cognitive impairment of elderly people were social support, age, regular exercising and instrumental activities of daily living.
Activities of Daily Living ; Aged* ; Aging ; Female ; Geriatric Assessment ; Humans ; Logistic Models ; Male ; Mental Disorders ; Physical Examination ; Risk Factors ; Social Problems ; Surveys and Questionnaires

We experienced a case of eisenmenger syndrome treated by simple surgical intervention. Eisenmenger syndrome refers to patients with congenital heart defects who have a systemic level of pulmonary arterial pressure and high pulmonary vascular resistance, with right-to-left or bidirectional shunting. Because a progressive rise in pulmonary vascular resistance may be better tolerated with an intracardiac communication, surgical repair in such patients may shorthen their life. But, urgent surgical intervention should be undertaken to reverse process if the pulmonary vascular disease is of recent origin. Patients who respond to vasoilator therapy, such as oxygen, are subjected to surgery. We reported a case of PDA with eisenmenger syndrome whose pulmonary vascular resistance fall following vasodilator, 100% oxygen, and closure of defect during cardiac catheterization, preoperatively, and who may faborable after simple surgical repair.
Arterial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Ductus Arteriosus, Patent* ; Eisenmenger Complex* ; Heart Defects, Congenital ; Humans ; Ligation* ; Oxygen ; Vascular Diseases ; Vascular Resistance

Dysgerminoma developed in a 21-year-old phenotypic female patient with 46,XY pure gonadal dysgenesis, Swyer syndrome. This patient presented with pelvic mass associated with abdominal pain and primay amenorrhea. Clinical characteristics showed a typical stigmata of gonadal dysgenesis: primary amenorrhea, sexual infantilism, a small uterus and left streak gonad. A 46,XY karyotype was made by lymphocyte culture. The patient was counseled to undergo operation, chemotherapy and hormon therapy. She underwent bilateral gonadectomy with total hysterectomy, partial omentectomy and multiple pelvic wall random biopsy. Histological examination revealed dysgenetic gonads with dysgerminoma. After surgery, the patient received chemotherapy and also was started on hormone replacement therapy. She is currently alive with no evidence of disease after 19 months from surgery.
Abdominal Pain ; Amenorrhea ; Biopsy ; Christianity ; Drug Therapy ; Dysgerminoma* ; Female ; Gonadal Dysgenesis ; Gonadal Dysgenesis, 46,XY* ; Gonads ; Hormone Replacement Therapy ; Humans ; Hysterectomy ; Karyotype ; Lymphocytes ; Sexual Infantilism ; Uterus ; Young Adult

Fitz-Hugh-Curtis syndrome (FHCS)-inflammation of the liver capsule (Perihepatitis) associated with genital tract infection-occurs in 4~14% of patients with pelvic inflammatory disease (PID). Generally presenting as sharp, pleuritic right upper quadrant pain, usually but not always accompanied by signs of salpingitis. It needs differential diagnosis such as cholecystitis, pyelonephritis. The pathogenesis of FHCS is incompletely understood. But Neisseria gonorrhoeae and Chlamydia trachomatis are thought to be the primary causative germs of FHCS. We make a report about FHCS in 19-year-old woman who had been sexual history recently.
Chlamydia ; Chlamydia Infections ; Chlamydia trachomatis ; Cholecystitis ; Diagnosis, Differential ; Female ; Hepatitis ; Humans ; Liver ; Neisseria gonorrhoeae ; Pelvic Inflammatory Disease ; Peritonitis ; Pyelonephritis ; Salpingitis ; Young Adult

PURPOSE: The purpose of this study was to identify the relationship between psychosocial factors and symptom experience of patients with cardiovascular disease over a 6-month follow-up period. METHOD: Baseline data for each of the 138 patients were collected. Eighteen patients were dropped for a final total of 120 patients in the present study. To monitor patients' symptom experience after discharge, each patient was interviewed by telephone, and interviewed directly with a questionnaire at each clinic visit. RESULTS: Mean scores for hostility, anger, anxiety, and depression were 51.63, 22.87, 48.95, and 41.21, respectively. Mean scores for the level of symptom experience at discharge, 3 months and 6 months after discharge were 32.83, 24.79, and 26.70, respectively. There were significant differences in the level of hostility by gender, BMI, job, and monthly income. Also the differences in the level of anxiety and depression were statistically significant according to gender and existence of spouse. In the regression analysis, depression was identified as the significant factor associated with symptom experience at discharge, 3 months, and 6 months after discharge. CONCLUSION: This study presented baseline data to elucidate whether psychosocial factors were associated with the progression of cardiovascular diseases. Accordingly, it suggests that nurses need to take into consideration psychosocial factor as well as physiological factor in symptom management for patients with cardiovascular disease.
Ambulatory Care ; Anger ; Anxiety ; Cardiovascular Diseases* ; Depression ; Follow-Up Studies* ; Hostility ; Humans ; Psychology* ; Surveys and Questionnaires ; Spouses ; Telephone

Background/Aims: To date, there is no standard tool to diagnose gastroesophageal reflux disease (GERD). Typically, GERD is a non-erosive reflux disease (NERD) that does not present endoscopic abnormalities. Confocal laser endomicroscopy (CLE) has been shown to be an effective tool to identify and diagnose GERD. We aimed to investigate the cellular and vascular changes in vivo and ex vivo through CLE in patients with GERD. Methods: Patients with refractory GERD who underwent mucosectomy were recruited. The distal esophagus was observed in vivo using CLE. Mucosectomy tissue was stained with acriflavine and CLE image was obtained ex vivo. We compared cellular and vascular changes in CLE between erosive reflux disease (ERD), NERD, and a control group. Results: Eleven patients who underwent anti-reflux mucosectomy and five control patients were enrolled in the study. Patients with ERD and NERD presented greater dilated intercellular space than patients in the control group on CLE image. The diameter, number, and cross-sectional area of the intra-papillary capillary loops (IPCLs) were significantly larger in the ERD group than in the NERD group. The irregular shape of the IPCLs were observed in both patients with ERD and NERD. Conclusions The irregular shape of the IPCLs were significantly correlated with a positive diagnosis of GERD. CLE may diagnose NERD with high sensitivity and accuracy.