No abstract available.

Miller Fisher syndrome is a syndrome of acute external ophthalmoplegia, ataxia and areflexia without significant motor or sensory deficit in the limbs and usually results in complete recovery without specific treatment. It's accurate anatomic lesion sites and pathogeneiss is still unknown. Recently we experienced a 57 year old man who had the sudden onset of ophthalmoplegia, ataxia, areflexia and albuminocytologic dissociation in CSF and completely recovered 2 1/2 months later.
Ataxia* ; Extremities ; Humans ; Middle Aged ; Miller Fisher Syndrome* ; Ophthalmoplegia

Miller Fisher syndrome is a syndrome of acute external ophthalmoplegia, ataxia and areflexia without significant motor or sensory deficit in the limbs and usually results in complete recovery without specific treatment. It's accurate anatomic lesion sites and pathogeneiss is still unknown. Recently we experienced a 57 year old man who had the sudden onset of ophthalmoplegia, ataxia, areflexia and albuminocytologic dissociation in CSF and completely recovered 2 1/2 months later.
Ataxia* ; Extremities ; Humans ; Middle Aged ; Miller Fisher Syndrome* ; Ophthalmoplegia

Various cancer types have been associated with cancer-related cerebral infarction. In this study, we describe the first case of cancer-related cerebral infarction in which the underlying disease was primary bone marrow lymphoma (PBML). A 79-year-old man presented with abruptly developed bilateral lower extremity weakness and confusion. Diffusion-weighted imaging on admission showed multiple cortical and subcortical embolic infarction lesions in multiple vascular territories. Diagnostic evaluations to determine the embolic source revealed no abnormalities. Laboratory testing demonstrated elevated D-dimer (2.59 μg/mL) but no other prothrombotic abnormalities. In suspicion of cancer-related stroke, we performed chest CT, abdomen CT, and FDG-PET to detect the hidden malignancy. Findings revealed no evidence of cancer; however, they did reveal signs of anemia (hemoglobin 9.0 g/dL). Bone marrow aspiration biopsy showed large atypical B cell involvement suggestive of high-grade B cell lymphoma. The patient was diagnosed with primary bone marrow diffuse large B-cell lymphoma initially presenting with ischemic stroke. Our case suggests that primary bone marrow cancer may be a candidate for the differential diagnosis of hidden malignancy in patients with suspected cancer-related stroke. Bone marrow biopsy may be essential for establishing an appropriate differential diagnosis in patients with abnormal hematologic findings.

PURPOSE: The purpose of this study was to examine the effect of professional autonomy, organizational commitment, and perceived patient safety culture on patient safety management activities of nurses in medium and small-sized hospitals.METHODS: A cross-sectional design was employed. Self-reported questionnaires were completed by 121 nurses with at least 3 months of working experience in medium and small-sized hospitals located in B city. Data were analyzed using descriptive statistics, a t-test, a one-way ANOVA, Pearson correlation coefficients, and a multiple regression analysis.RESULTS: Professional autonomy (r=.22, p=.016), organizational commitment (r=.34, p < .001), and perceived patient safety culture (r=.55, p < .001) had a statistically significant positive correlation with patient safety management activities. The factors that might affect patient safety management activities were professional autonomy (β=.23, p=.003) and perceived patient safety culture (β=.55, p < .001). The explanatory power of these factors for patient safety management activities was 33.5% (F= 21.19, p < .001).CONCLUSIONS: The development of repetitive and continuous education programs is needed to improve a nurse's professional autonomy and perceived patient safety culture.
Education ; Humans ; Organizational Culture ; Patient Safety ; Professional Autonomy ; Safety Management

No abstract available.
Humans

Varicose veins are consistent with physically dilated superficial veins ≥3 mm. Physiologically, chronic venous insufficiency is an advanced chronic venous disease with functional abnormalities. Essentially, the shape of the vein is directly influenced by hydrostatic pressure. Ambulatory venous pressure is increased as shunt formation and vein will be dilated by the connection with deep venous refluxes. Hydrostatic parodox in varicose veins is that the ambulatory venous pressure is not directly related with vein diameter but with shunt formation with valve insufficiency. Mean ambulatory venous pressure of 10–30 mmHg is considered as normal, 31–45 mmHg as intermediate and >45 mmHg as severe venous hypertension. Diameter measurement is used in the diagnosis of varicose veins, but treatment need to be more focused to remove hydrostatic pressure rather than diameter of vein in respect to improve symptoms related with varicose veins. Nevertheless, there are some concerns for the treatment of large veins. From the guidelines endothermal ablation is recommended than non-thermal ablation for >10 mm large varicose vein. Large veins might increase the incidence of endothermal heat induced thrombosis. Caprini score more than 7 will be benefited from chemoprophylaxis for large vein. For the compression therapy, inelastic compression is recommended than elastic compression to improve the function of calf muscle pump.

A total of 150women with singleton pregnancies who were delivered between 37 and 42weeks gestation had ultrasound scans on elective cesarean section day. The biparietal diameter(BPD), head circumference(HC), abdominal circumference(AC) and femur length(FL) were measured in all cases. Equations of estimated fetal body weight(BWT) for Korean term fetuses using AC alone, BPD/AC, AC/FL, HC/AC/FL, BPD/AC/FL, BPD/HC/AC/FL were made by stepwise multiple regression analysis and were compared with foreign equations such as Campbell(AC), Shepard(BPD/AC), Hadlock I(AC/FL), Hadlock II(HC/AC/FL), Hadlock III(BPD/AC/FL), and Hadlock IV(BPD/HC/AC/FL). The results were as follows. 1. The equations of BWT by sonographic measurement were Equation1 (AC) logeBWT=6.105936+0.005957X(AC) (R=0.876) Equation2 (BPD,AC)logeBWT=6.53614548+0.00004963X(ACXBPD) (R=0.929) Equation3 (AC,FL) logeBWT=6.25336442+0.00751602X(FL)+0.00005155X(ACXFL) (R=0.950) Equation4(HC,AC,FL) logeBWT=6.39631346+0.00004823X(ACXFL)+0.00002023X(FLXHC) (R=0.953) Equation5(BPD,AC,FL) logeBWT=5.99934074+0.00871394X(BPD)+0.00005132X(ACXFL) (R=0.960) 2. When BPD, AC and FL were measured, the addition of HC didn,t affected to accuracy of EFW 3. The best results of all equations were obtained with our equation 5(Mean error=2.36gm, Mean absolute error=96.39gm, Mean deviation + SD(%)=0.07+0.37) and among foreign equations, the best results were with Hadlock III equation(Mean error=18.35gm, Mean absolute error=107.82gm, Mean deviation + SD(%)=-0.46+0.42) 4. The equations using AC/FL (our equation 3, Hadlock I) are more accurate than those using BPD/AC (our equatione 2, Shepard) when utilizing two parameters. Therefore, equation using AC/FL is recommended when the BPD is unobtainable at term or labor 5. The percentage of cases in which the EFW was within +5% and +200gm of the actual birth weight was highest at our equation 5 for 82% and 89%, Hadlock IV equation for 79%, 88%. 6. Our equations had relatively an equal tendency to under- and overestimate fetal weight, but foreign equations, especially Campbell and Hadlock II equations tended to underestimate. 7. Analysing according to actual birth weight, our all equations gave the most accurate estimates of fetal weigh for birth weight group between 3000-3499gm, but for birth weight group above 3500gm, that was not. At birthweight group above 3500gm, the equations depend on femur length are more accurate than the equations independ on fumr length.
Birth Weight ; Cesarean Section ; Female ; Femur ; Fetal Weight* ; Fetus ; Head ; Pregnancy ; Ultrasonography

OBJECTIVES: This study was conducted to investigate providers' perspectives on current challenges in implementing a program for prevention and management of childhood obesity and adoption of mobile phone as a potential solution of leveraging multimodal delivery and support in a school setting. METHODS: The qualitative data were collected through face-to-face in-depth interviews with 23 elementary-school teachers, 6 pediatricians, and 6 dieticians from community health centers and analyzed using a qualitative research methodology. RESULTS: Current challenges and potential solutions of obesity-prevention and -management program for obesity program for elementary school children were deduced as two themes each. Lack of tailored intervention due to limited recipient motivation, lack of individualized behavioral intervention, and different environmental conditions can be solvable by mobile technology-based personalized intervention which brings about interactive recipient participation, customized behavioral intervention, and ubiquitous accessibility. Lack of sustainable management due to stigmatization, limited interactions between program providers and inconsistent administrative support can be handled by multimodal support based on school setting using mobile platform providing education of health promoting behaviors toward larger scale and interactive networking between program participants, and minimizing administrative burden. CONCLUSIONS: Adoption of mobile-based health management program may overcome current limitations of child obesity program such as lack of tailored intervention and sustainable management via personalized intervention and multimodal supports although some concerns such as increased screen time need to be carefully considered in a further study.
Cell Phones* ; Child* ; Community Health Centers ; Education ; Humans ; Motivation ; Nutritionists ; Obesity* ; Pediatric Obesity ; Qualitative Research ; Stereotyping

The depolarizing neuromuscular blocking agent succinylcholine, which was synthesized by Hunt and Taveau in 1906, is still regarded as the drug of choice when speed of onset and good intubating conditions matter most. This agent has several disadvantages, some of which may be unpredictable, serious and immediate, for example, muscle pain, bradycardia, rise in intragastric pressure, increase in intraocular pressure and elevation of serum potassium. These disadvantages may be regarded as the side effects of depolarization and indicate a need for a nondepolarizing neuromuscular blocking agent with rapid onset and good muscle relaxation. Simpson et al. described the neuromuscular blocking properties of the nondepolarizing .neuromuscular blocking agent, Fazadinium (AH 8165) in 1972. This initial work indicated a more rapid onset of action than occurs with succinyleholine and without muscle fasciculation or concomitant rise in plasma potassium concentration. However, Coleman et al., Young, t al., Hartley and Fidler, and Metha et al., concluded that using succinylcholine, a ignificantly greater number of patients had excellent intubating conditions at predetermined times after administration than when using Fazadinium. Several reports have indicated that administration of a small dose of nondepolarizing neuromuscular blocking agents would markedly diminish the fasciculation and muscle pains which so frequently occur, when succinylcholine is given. Many other reports have indicated that administration of a small dose of nondepolarizing neuromuscular blocking agents could attenuate or eliminate the adverse effects of succinylcholine such as increased intra-gastric pressure and intraocular pressure, bradycardia, arrhythmia and hyperkalemia. Several investigators have recommended that when small doses of nondepolarizing neuromuscular blocking aKent are given before succinylcholine administration, larger doses of succinylcholine should be given to achieve satisfactory relaxation. A comparative study using d-tubocurarine, gallamine and pancuronium for precurarization indicates that any of them successfully attenuates fasciculation. They have a little antagonizing effect of vocal cord relaxation after succinylcholine administration, but there was no difficulty during endotracheal intubation.
Arrhythmias, Cardiac ; Bradycardia ; Fasciculation ; Gallamine Triethiodide* ; Humans ; Hyperkalemia ; Intraocular Pressure ; Intubation, Intratracheal ; Muscle Relaxation ; Myalgia ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Pancuronium* ; Plasma ; Potassium ; Relaxation ; Research Personnel ; Succinylcholine ; Tubocurarine* ; Vocal Cords