This quasi -experimental study was intended to test the effect of self-help group program, which is one of the way to enhance adaptation and quality of life to mastectomy patients. Data was collected from July 14, 1998 to Oct. 31, 1998 at two Medical Center in Seoul. The subjects for this study were the patients who had undergone mastectomy and were follow-up: 14 in experimental group and 14 in control group matched with age and treatment. The instruments for this study were adaptation in Lee(1994)'s physical symptom questionnaire, Zung's Self-rating Depression Scale (SDS, 1965), and Self-rating Anxiety Scale (SAS, 1970), quality of life in Spranger(1996)'s and No(1988)'s Quality of Life Questionnaire. The self-help group program for mastectomy patients was developed based on literature review and pilot study by the investigator. The subjects of experimental group were participated in 6 weeks self - help group program and were received arm and shoulder exercise, informational support, and interpersonal support by group members. The control group were received no intervention. Both group answered questionnaires prior to intervention and 6 weeks later. The data analyzed by frequency, chi-test, Mann-Whitney U test, Wilcoxon Signed Rank test, Pearson's Correlation Coefficient and Stepwise Multiple Regression using SPSS WIN. The results are as follows; Hypothesis 1, The experimental group with the self-help group program will have a higher score on adaptation state than control group. was not supported. But the posttest score of anxiety and depression in experimental group were declined and the depression score was reduced relatively. Hypothesis 2, The experimental group with the selp-help group program will have a higher score on quality of life than control group. was not supported. But the posttest score of quality of life in experimental group was reduced relatively. Hypothesis 3, The higher adaptation state of mastectomy patients, the higher quality of life. was supported(r=.80, p .001). Additionally, the lower physical symptom, depression and anxiety, the higher quality of life. And depression, which was the main predictor of quality of life, accounted for 59.5%, depression and anxiety accounted for 65.5% of the variance in quality of life. In conclusion, when the self-help group program was intervened to mastectomy patients, it was tended to increase quality of life and to reduce depression and anxiety. So self-help group program can be considered useful nursing intervention effect on adaptation and quality of life of mastectomy patients. With discussion, I suggest repeated further research on self-help group with appropriate sample size and longitudinal study. Also during adjuvant therapy, it is needed to develop convenient method to be supported from peer group and family, such as computer mediated support group.
Anxiety ; Arm ; Depression ; Follow-Up Studies ; Humans ; Longitudinal Studies ; Mastectomy* ; Nursing ; Peer Group ; Pilot Projects ; Quality of Life* ; Surveys and Questionnaires ; Research Personnel ; Sample Size ; Self-Help Groups* ; Seoul ; Shoulder

PURPOSE: Most children who have been treated for craniopharyngioma eventually develop multiple pituitary hormone deficiencies as well as growth hormone deficiency(GHD). However, some of them may grow normally or even have accelerated growth velocity despite GHD postoperatively. This study was undertaken to evaluate several factors influencing change in growth velocity after surgery for craniopharyngioma in patients with GHD. METHODS: Fifteen patients operated on for craniopharyngioma had a pharmacological assessment of hypothalamic-pituitary function and at least two standard GH provocation tests. All patients had multiple pituitary hormone deficiencies including GHD after surgery. Patients were classified in two groups according to their growth rate during the first postoperative year. Group 1 consisted of 6 children with normal growth velocity or more than 2 standard deviation score(SDS) above the normal mean, and group 2 consisted of 9 children with decreased growth velocity more than 2 SDS below the normal mean. RESULTS: Height velocity was 8.3+/-.2 cm/year in group 1 and 2.8+/-.3 cm/year in group 2 during the first year. During the second year, height velocity was 4.4+/-.3 cm/year and 3.3+/-.4 cm/year, respectively. Body mass index(BMI) change between before and after surgery was 0.83+/-.4 kg/m2 in group 1 and 0.03+/-.3 kg/m2 in group 2 but there was no difference between both groups. However, BMI changes was correlated positively with height SDS change for 1 year following surgery in 15 patients(P<0.05, r=0.601). Prolactin levels before surgery were not significant difference between group 1 and group 2. However, there was a significant positive correlation between prolactin levels before surgery and height SDS change(P<0.01, r=0.671). Postoperative IGF-1 levels were low in all patients except one, who showed decreased growth rate. CONCLUSION: In this study, there were no significant differences in height velocity, BMI, prolactin, and IGF-1 levels between normal growth group and growth failure group after surgery. Further studies are needed to find out any other growth promoting factors related to growth without growth hormone.
Child* ; Craniopharyngioma* ; Growth Hormone* ; Humans ; Insulin ; Insulin-Like Growth Factor I ; Obesity ; Prolactin

PURPOSE: This study was undertaken to identify the frequencies and the risk factors of microvascular complications in subjects with type 1 diabetes mellitus METHODS: The frequencies and their relation to risk factors of microvascular complications were analyzed in 29 type 1 diabetes mellitus subjects with duration of disease more than 5 years. Microvascular disease was defined as the presence of either retinopathy, microalbuminuria or neuropathy. RESULTS: The overall prevalence rate of microvascular disease was 8/29(27.6%). Retinopathy has developed in 3 patients(10.3%), microalbuminuria in 7 patients(24.0 %) and neuropathy in 5 patients(17.2%). The mean HbA1C was significantly higher in the patients with microvascular complications(11.6+/-.2% in microvascular complication group vs 9.3+/-.6% in control group). CONCLUSION: In childhood onset type 1 diabetes mellitus, poor glycemic control is an important risk factor for microvascular complications.
Diabetes Mellitus, Type 1* ; Humans ; Prevalence ; Risk Factors*

PURPOSE: The purpose of this study was to evaluate clinical manifestation, etiology and prognosis of hypocalcemic infants who were admitted with seizure. METHODS: We reviewed medical records of 32 infants admitted at the Asan Medical Center with hypocalcemic seizure retrospectively. We classified patients into vitamin D deficiency group(n=7, 21.9%), transient hypoparathyroidism group(n=4, 12.5%), relative hypoparathyroidism with hyperphosphatemia group(n=16, 50%), and others(n=5, 15.6%) according to the laboratory results. RESULTS: Of the 32 patients, 29 patients were improved. There were no differences in gestational age and birth weight among the three groups. In the vitamin D deficiency group, age of onset was later than those of the transient hypoparathyroidism group and relative hypoparathyroidism with hyperphosphatemia group(51.6+/-2.7 vs 8.3+/-.5, 8.2+/-.6 days). In the age when all laboratory results were normalized, transient hypoparathyroidism group was younger than those of vitamin D deficiency group and relative hypoparathyroidism group(33.2+/-4.6 vs 93.6+/-8.5, 77.1+/-2.4 days). In the total treatment period, relative hypoparathyroidism with hyperphosphatemia group was longer than those of vitamin D deficiency group and transient hypoparathyroidism group(68.9+/-3.5 vs 42.0+/-5.0, 25.0+/-4.3 days). Others included two 22q11.2 deletion syndrome patients, a congenital hypoparathyroidism, a pseudohypoparathyroidism, and an early neonatal hypocalcemia. CONCLUSION: Transient hypoparathyroidism and hyperphosphatemia were major causes of neonatal hypocalcemia. And high calcitonin and peripheral organ resistance to parathyroid hormone act on hypocalcemia. In infants after one month, vitamin D deficiency was also an important cause of hypocalcemia. Most of the patients were improved within 1-2 months after proper management, but relative hypoparathyroidism with hyperphosphatemia group needed longer treatment. So, it is necessary to perform a systematic study for several complex causes that explain above fact.
Birth Weight ; Calcitonin ; Chungcheongnam-do ; DiGeorge Syndrome ; Gestational Age ; Humans ; Hyperphosphatemia ; Hypocalcemia ; Hypoparathyroidism ; Infant* ; Medical Records ; Parathyroid Hormone ; Prognosis ; Pseudohypoparathyroidism ; Retrospective Studies ; Seizures ; Vitamin D Deficiency

PURPOSE: This study was undertaken to determine whether the clinical presentation of patients with central precocius puberty(CPP) varies according to the etiology, whether this permits the differentiation between idiopathic and organic forms and to examine whether LH determination in a single timed blood sample after GnRH administration is sufficient to diagnose CPP. METHODS: This study included 33 girls with signs of breast development, of whom 23 were diagnosed as definite central precocious puberty. Sixteen patients had idiopathic CPP; the remaining 7 patients had organic CPP. Ten patients were classified as non-CPP. Potential clinical and laboratory predictors of CNS abnormalities were assessed and GnRH stimulation test was done. RESULTS: The age of onset in patients with organic CPP was 4.11+/-2.08 years, whereas the age in patients with idiopathic CPP was 7.25+/-1.34 years. This parameter is the only one showing statistical significance. We compared sensitivities and specificities at 0, 15, 30, 60, 90 and 120 min which yielded sensitivities of 8.7%, 87.0%, 91.3%, 87.0%, 73.9%, 60.9%. CONCLUSION: It is impossible to exclude a central nervous system lesion in patient with central precocious puberty without performing central nervous system imaging. However, this study indicates earlier the onset of disease, higher the possibility of presence of CNS lesion. According to the mean GnRH stimulated LH levels and sensitivity at each times, a single blood sample obtained for LH determined after GnRH administration at 30 min can be used to diagnose the central precocious puberty.
Age of Onset ; Breast ; Central Nervous System* ; Female ; Gonadotropin-Releasing Hormone* ; Humans ; Luteinizing Hormone ; Puberty, Precocious*

No abstract available.
Adult* ; Humans ; Lower Extremity*

The ankle is a modified complex hinge joint consisting of the distal tibio-fibula joint (Syndesmosis), and the ankle joint proper(hinge joint), and is important in weight bearing, standing and walking. So, the goals of treatment of ankle fracture are anatomical positioning of talus in the mortise and regaining a smooth articular suface. Unless these requisites are achieved by treatment, post-traumatic arthritis is likely to occur. We analyzed 120 cases of ankle fracture, most of which were treated surgically by A-0 method, in Department of Orthopaedic Surgery, Hyundai Haesung Hospital from January, 1982 to December 1985. The results are as follows; 1. The most common victim was 3rd–4th decades man, and the cause was direct blow. 2. The most common type was pronation-external rotation type of Lauge-Hansen classification, and Type A of Danis-Weber type. 3. The more favorable result was noted in Danis-Weber type A than type B and type C,and noted worst result in pilon fracture. 4. Favorable results can be gained by semi-tubular plate in fibular fracture than any other fixation material. 5. On application of semi-tubular plate, there were no significant differences in results between that placed posteriorly and that placed laterally. 6. We did not transfix the distal tibio-fibular joint in stable Danis-Weber type C injury without any specific sequellae. 7. We obtained better result by removal of transfixing screw 6 weeks after operation. 8. We obtained good results with only 3 weeks immobilization after operation.
Ankle Fractures ; Ankle Joint ; Ankle ; Arthritis ; Classification ; Immobilization ; Joints ; Methods ; Talus ; Walking ; Weight-Bearing

No abstract available.
Anxiety* ; Depression* ; Headache*

Backgroud: To evaluate the appropriateness of the requests of the emergency transfusions, 3 year experiences in the use of the immediate-spin crossmatched blood(ISMB) for emergency transfusions in tertiary hospital were reviewed. METHODS: Low-isotonic salt solution was used as a cell suspension and crossmatchings were continued including antiglobulin phase after issuing of the ISMB. The number of cases, the issuing time, sex, age, reasons for emergency transfusions and vital signs of the patients were retrospectively reviewed. Only cases of massive transfusions and classes III and IV according to the Advanced Trauma Life Support(ATLS) classification were considered appropriate. RESULTS: 1. The total number of emergency transfusions were 614 and 0.53 cases per day. The average age of the patients was 44.7+/-17.8 and male to female ratio was 2:1. And 357 cases(58.2%) were performed during off hours when the hospital was not fully staffed. 2. Six hundred thirteen cases(99.8%) were transfused with compatible blood. However, one case(0.2%) was found to have anti-E antibody during the emergency transfusion. 3. Massive transfusion was performed only in 32% of the total cases and the reasons of emergency transfusions in remaining cases were upper gastrointestinal bleeding(53%), trauma(19.2%) and obstetrical problems(16.8%). 4. Of the total 519 cases reviewed, 392 cases(75.5%) were considered appropriately, and 127 cases(24.5%) were considered inappropriately selected for emergency transfusions. CONCLUSIONS: One fourth of emergency transfusions was found to be inappropriate. We believe that the use of ISMB for emergency transfusions should be carefully requested by physicians and educational programs for the use of ISMB is clearly indicated for emergency transfusion management.
Classification ; Emergencies* ; Female ; Humans ; Male ; Retrospective Studies ; Tertiary Care Centers ; Vital Signs

To study the clinical characteristics and treatment results of childhood soft tissue sarcoma, the retrospective study was performed on 67 patients with soft tissue sarcoma, experienced at the Department of Pediatrics, Seoul National University Hospital from January, 1982 to July, 1990. The median age of 67 soft tissue sarcoma patients was 4 years 5 months and age distribution showed that 0-4 year age group was most common (55.2%). The sex ratio of male to female was 1.2:1. There were 3 cancers among relatives of soft tissue sarcoma patients, including one cancer among first-degree relatives. As for pathological classification, rhabdomyosarcoma (67.1%) was the most common childhood soft tissue sarcoma, followed by malignant Schwannoma (8.9%), extraskeletal Ewing's sarcoma (6.0%), infantile fibrosarcoma (4.5%), malignant fibrous histiocytoma (3.0%), malignant hemangiopericytoma (3.0%), and there were 1 case each of angiosarcoma, leiomyosarcoma, synovial sarcoma, malignant mesenchymoma and mesenchymal chondrosarcoma. The median age of 45 rhabdomyosarcoma patients was 3 years 8 months and age distribution showed that 0-4 year age group was most common (64.5%). Twenty three patients were male and 22 were female. The histologic subtype of rhabdomyosarcoma was embryonal type in 38 patients (84.5%), alveolar type in 5 patients (11.1%) and unclassified type in 2 patients (4.4%). As for primary site of soft tissue sarcomas, the most frequent site was the head and neck region (32.8%) including parameningeal region (13.4%) and orbit (6.0%), followed by extremities (20.9%), trunk (19.4%), retroperitoneum and pelvis (11.9%), urogenital region (7.5%), perineum and perianal region (4.5%) and other region (3.0%). As for primary site of 45 rhabdomyosarcoma cases, the most frequent site was also the head and neck region (37.8%). The most common initial symptom of soft tissue sarcoma patients was mass (68.7%). As for Intergroup Rhabdomyosarcoma Study clinical grouping system of 67 soft tissue sarcoma patients, clinical group III (58.2%) was most common, followed by clinical group II(20.9%), IV (14.9%) and I (6.0%). Of 10 cases of clinical group IV with distant metastasis, lung (8 cases) was the most common metastaic region and other metastatic regions were bone, kidney, liver and bone marrow. As for IRS clinical grouping system of 45 rhabdomyosarcoma patients, clinical group III was most common (68.9%). Of 6 cases of clinical group IV, lung (5 cases) was also the most common metastatic region, followed by kidney and liver. From 1982 to 1985, chemotherapy was done with pulse VAC or pulse VAdrC-VAC regimen based on IRS-I and IRS-II. From 1986, patients in clinical group I and II received vincristine and actinomycin-D for 1 year and patients in clinical group III, IV and II with alveolar histologic subtype(unfavorable histologic group) received vincristine, actinomycin-D, adriamycin, cyclophosphamide and cisplatinum based on IRS-III. Radiation therapy was administered to patients in clinical group II, III and IV. Of 67 cases of soft tissue sarcoma, 54 case were eligible for treatment analysis. The 3 year disease free survival (DFS) of all 54 cases was 54.1%, 3 year DFS of clinical group I and II was 83.9%,3 year DFS of clinical group III and IV before 1986 was 35.7% and after 1986 was 48.2%. Of 45 cases of rhabdomyosarcoma, 41 cases were eligible for treatment analysis. The 3 year DFS of all 41 cases was 49.1%,3 year DFS of clinical group I and II was 87.5%,3 year DFS of clinical group III and IV before 1986 was 27.2% and after 1986 was 45.0%. Patients in clinical group I and II who had no gross residual tumor after primary surgical excision had best prognosis with 3 year DFS approximating 90% with only 2 drugs regimen, significantly better than patients in clinical group III and IV with 3 year DFS below 50% even after intensifying chemotherapy since year 1986. This analysis suggests that total surgical removal is very important for improving prognosis and should be undertaken where possible in all patients without distant metastasis. Treatment results also showed that after year 1986 with intensification of chemotherapy, 3 year DFS of clinical group III and IV as well as early toxic deaths increased, and after lowering doses of chemotherapeutic agents of regimen 35 of IRS-III, treatment results improved much. Therfore to improve prognosis of patients with gross residual tumor after surgical excision of biopsy and patients with distant metastasis at diagnosis, intensified multiagent chemcherapeutic regimen with adequate dose modification should be done to lower early toxic deaths.
Age Distribution ; Biopsy ; Bone Marrow ; Chondrosarcoma, Mesenchymal ; Classification ; Cyclophosphamide ; Diagnosis ; Disease-Free Survival ; Doxorubicin ; Drug Therapy ; Extremities ; Female ; Fibrosarcoma ; Head ; Hemangiopericytoma ; Hemangiosarcoma ; Histiocytoma, Malignant Fibrous ; Humans ; Kidney ; Leiomyosarcoma ; Liver ; Lung ; Male ; Mesenchymoma ; Neck ; Neoplasm Metastasis ; Neoplasm, Residual ; Neurilemmoma ; Orbit ; Pediatrics ; Pelvis ; Perineum ; Prognosis ; Retrospective Studies ; Rhabdomyosarcoma ; Sarcoma* ; Sarcoma, Ewing ; Sarcoma, Synovial ; Seoul ; Sex Ratio ; Survival Rate ; Vincristine