PURPOSE: The purpose of this prospective multi-institutional study was to evaluate the nutritional status of patients undergoing radiotherapy (RT) for treatment of head and neck, lung, or gastrointestinal cancer. MATERIALS AND METHODS: A total of 1,000 patients were enrolled in this study at seven different hospitals in Seoul, Korea between October 2009 and May 2010. The nutritional status of patients after receiving 3 weeks of RT was evaluated using subjective global assessment (SGA). The nutritional status of each patient was rated as well nourished (A), moderately malnourished (B), or severely malnourished (C). RESULTS: The mean age of patients in this study was 59.4 +/- 11.9 years, and the male to female ratio was 7:3. According to the SGA results, 60.8%, 34.5%, and 4.7% of patients were classified as A, B, or C, respectively. The following criteria were significantly associated with malnutrition (SGA B or C; p < 0.001): loss of subcutaneous fat or muscle wasting (odds ratio [OR], 11.473); increased metabolic demand/stress (OR, 8.688); ankle, sacral edema, or ascites (OR, 3.234); and weight loss > or =5% (OR, 2.299). CONCLUSION: SGA was applied successfully to assess the nutritional status of most patients. The prevalence of malnutrition in a radiation oncology department was 39.2%. The results of this study serve as a basis for implementation of nutrition intervention to patients being treated at radiation oncology departments.
Animals ; Ankle ; Ascites ; Edema ; Female ; Head ; Humans ; Korea ; Lung ; Male ; Malnutrition ; Muscles ; Neck ; Nutrition Assessment ; Nutritional Status ; Prevalence ; Prospective Studies ; Radiation Oncology ; Subcutaneous Fat ; Weight Loss

PURPOSE: To determine the patterns of evaluation and treatment in patients with breast cancer after mastectomy and treated with radiotherapy. A nationwide study was performed with the goal of improving radiotherapy treatment. MATERIALS AND METHODS: A web-based database system for the Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Randomly selected records of 286 eligible patients treated between 1998 and 1999 from 17 hospitals were reviewed. RESULTS: The ages of the study patients ranged from 20 to 80 years (median age 44 years). The pathologic T stage by the AJCC was T1 in 9.7% of the cases, T2 in 59.2% of the cases, T3 in 25.6% of the cases, and T4 in 5.3% of the cases. For analysis of nodal involvement, N0 was 7.3%, N1 was 14%, N2 was 38.8%, and N3 was 38.5% of the cases. The AJCC stage was stage I in 0.7% of the cases, stage IIa in 3.8% of the cases, stage IIb in 9.8% of the cases, stage IIIa in 43% of the cases, stage IIIb in 2.8% of the cases, and IIIc in 38.5% of the cases. There were various sequences of chemotherapy and radiotherapy after mastectomy. Mastectomy and chemotherapy followed by radiotherapy was the most commonly performed sequence in 47% of the cases. Mastectomy, chemotherapy, and radiotherapy followed by additional chemotherapy was performed in 35% of the cases, and neoadjuvant chemoradiotherapy was performed in 12.5% of the cases. The radiotherapy volume was chest wall only in 5.6% of the cases. The volume was chest wall and supraclavicular fossa (SCL) in 20.3% of the cases; chest wall, SCL and internal mammary lymph node (IMN) in 27.6% of the cases; chest wall, SCL and posterior axillary lymph node in 25.9% of the cases; chest wall, SCL, IMN, and posterior axillary lymph node in 19.9% of the cases. Two patients received IMN only. The method of chest wall irradiation was tangential field in 57.3% of the cases and electron beam in 42% of the cases. A bolus for the chest wall was used in 54.8% of the tangential field cases and 52.5% of the electron beam cases. The radiation dose to the chest wall was 45~59.4 Gy (median 50.4 Gy), to the SCL was 45~59.4 Gy (median 50.4 Gy), and to the PAB was 4.8~38.8 Gy, (median 9 Gy) CONCLUSION: Different and various treatment methods were used for radiotherapy of the breast cancer patients after mastectomy in each hospital. Most of treatment methods varied in the irradiation of the chest wall. A separate analysis for the details of radiotherapy planning also needs to be followed and the outcome of treatment is needed in order to evaluate the different processes.
Breast Neoplasms ; Breast* ; Chemoradiotherapy ; Drug Therapy ; Humans ; Korea* ; Lymph Nodes ; Mastectomy* ; Mastectomy, Radical ; Radiotherapy ; Thoracic Wall

PURPOSE: This study was aimed at exploring the current status of graduate programs for an advanced practice nurse(APN) to recommend future directions of APN education. METHODS: A total of 142 students enrolled in seven APN specialty programs, 67 professors who were involved in APN education, and nine nurse administrators participated in the study. Data was collected by questionnaires and focus group interviews. RESULTS: The current definition of APN was found not to be specific enough to represent expected roles of APN in regards to knowledge, attitudes, roles, and skills. Standard curricula employed regardless of the area of APN specialty, lack of qualified clinical practice settings, as well as prepared instructors were found to be problematic. CONCLUSION: The following needs to be addressed: 1. redefining of APN roles, 2. tailoring specialty areas of APN, 3. consolidating educational programs, and 4. ensuring APN role models and faculty. Suggesting a CNS role in Korean APN, areas of APN should be rearranged toclarify their roles and educational programs need to be further developed to meet the expectations and quality of APNs. It is necessary to ensure APN's employment in the health care system by laws and policies to perform advanced nursing roles.
Adult ; Curriculum ; Education, Nursing, Continuing ; Education, Nursing, Graduate ; Educational Measurement ; Focus Groups ; Humans ; Interviews as Topic ; Middle Aged ; Nurse Clinicians/*education ; Nurse Practitioners/*education ; Nursing Evaluation Research ; Questionnaires ; Societies, Nursing ; Specialties, Nursing/*education

We report a patient who developed a hydromediastinum associated with the insertion of a central venous catheter. A 32-year-old male, who presented for left nephroureterectomy, had a central venous catheter inserted after general anesthesia. The patient subsequently showed acute respiratory distress after extubation. His right neck was severely edematous and the chest radiograph revealed a widened mediastinal shadow. The exploratory neck incision showed fluid collection at the neck and mediastinum.
Adult ; Anesthesia, General ; Catheterization* ; Catheters* ; Central Venous Catheters ; Humans ; Jugular Veins* ; Male ; Mediastinum ; Neck ; Radiography, Thoracic

BACKGROUND AND OBJECTIVES: Positive correlations between quantitative coronary angiography and functional indexes of coronary stenosis are well known in angina pectoris. However, there is little data concerning correlations with acute myocardial infarction (AMI). The objective of this study was to evaluate the differences in correlation of functional severity and luminologic severity between patients with angina and acute myocardial infarction. SUBJECTS AND METHODS: The study population consisted of 23 patients with AMI and 25 patients with angina pectoris. We performed intravascular ultrasound (IVUS) and intracoronary pressure measurement following diagnostic coronary angiography, and measured angiographic diameter stenosis (DST), minimal luminal diameter (MLD), minimal luminal area (MLA), and reference area stenosis (r-AST). Additionally, the fractional flow reserve (FFR) was defined by the ratio of the distal mean coronary pressure (Pd) to the aortic mean pressure (Pa). RESULTS: The IVUS parameters and DST in patients with AMI showed more severe stenosis than seen in patients with angina; MLD (1.37+/-0.30 mm vs 1.73+/-0.63 mm, p<0.05), MLA (1.99+/-0.80 mm 2 vs 3.20+/-2.25 mm 2, p<0.05), r-AST (79+/-9% vs 64+/-24%, p<0.05), DST (78+/-14% vs 68+/-21%, p<0.05) respectively. FFR showed no significant difference between the patients with AMI and angina (0.733+/-0.14 vs 0.729+/-0.14, p>0.05). FFR was correlated less with r-AST in patients with myocardial infarction than angina ( - 0.55 vs - 0.84). The r-AST in patients with AMI, in order to be the best cut-off values that fit with a FFR<0.75, was higher than seen in patients with angina (83% vs 67%). CONCLUSION: FFR in AMI was not significantly different from that seen in angina despite the presence of a significant difference of IVUS parameters between the two patient groups. The functional severity of stenosis in relation to its luminologic severity may be lessened following acute myocardial infarction.
Angina Pectoris ; Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis* ; Humans ; Myocardial Infarction ; Phenobarbital ; Ultrasonography

BACKGROUND AND OBJECTIVES: Assessment of left ventricular systolic function is an important clinical variable with respect to diagnosis, prognosis and treatment in various clinical situation. Automatic quantification of ventricular volume and ejection fraction by delineating 3 dimensional endocardial boundaries from the gated perfusion SPECT was validated. The purposes of this study were to assess the agreement of left ventricular ejection fraction determined by two-dimensional echocardiography and automatic quantification of perfusion SPECT and compare different echocardiographic methods with the reference method, automatic quantification of perfusion SPECT. METHOD: Twenty seven patients (20 men, 7 women; mean age 60+/-12) with acute myocardial infarction (anterior: 16, inferior: 7, lateral: 4) and twenty one patients (12 men, 9 women; mean age 60+/-12) without myocardial infarction history and regional wall motion abnormality in echocardiography were studied. All patients had two-dimensional echocardiography and 201Tl perfusion SPECT performed within 5 days of each other. Ejection fraction of left ventricle was calculated by echocardiography using modified Simpson's method and M-mode method. Also, ejection fraction of left ventricle was estimated by 201Tl perfusion SPECT using automatic software (quantitative gated SPECT[QGS]; Cedars-Sinai Medical Center, Los Angels, CA). RESULTS: The agreement of ejection fraction between M-mode method and QGS (limit of agreement -3.48, 3.2; average limit of agreement 6.68) in control group was better than that between modified Simpson's method and QGS (limit of agreement 0.04, 8.42; limit of agreement average limit of agreement 8.38). But, The agreement of ejection fraction between modified Simpson's method and QGS in the acute myocardial infarction group (limit of agreement; -15.31, 10.01; average limit of agreement 12.66) was better than that between M-mode method and QGS (limit of agreement -17.82, 13.86; average limit of agreement 15.84). The agreement of ejection fraction between modified Simpson's method and QGS (limit of agreement; -8.49, 5.74; average limit of agreement 7.12) in the anterior myocardial infarction was more accordancy than lateral and inferior wall infarction (limit of agreement; -12.11, 13.74; average limit of agreement 12.92). CONCLUSION: The M-mode method in patients without regional wall motion abnormality and modified Simpson's method in patients with regional wall motion abnormality, especially in anterior wall infarction seen to be useful method for the assessment of left ventricular ejection fraction.
Diagnosis ; Echocardiography* ; Female ; Heart Ventricles ; Humans ; Infarction ; Male ; Myocardial Infarction ; Perfusion ; Prognosis ; Stroke Volume ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: We compared estimates of ejection fraction (EF) determined by gated Tl-201 perfusion SPECT (g-TI-SPECT) with those by gated blood pool (GBP) scan. MATERIALS AND METHODS: Eighteen subjects underwent g-TI-SPECT and GBP scan. After reconstruction of g-TI-SPECT, we measured EF with Cedars software. The comparison of the EF with g-TI-SPECT and GHP scan was assessed by correlation analysis and Bland Altman plot. RESULTS: The estimates of EF were significantly different (p<0.05) with g-TI-SPECT (40%+/-14%) and GBP scan (43%+/-14%). There was an excellent correlation of EF between e-TI-SPECT and GBP scan (r=0.94, p<0.001). The mean difference of EF between GRP scan and g-TI- SPECT was +3.2%, Ninety-five percent limits of agreement were +9,8%. EF between g-TI-SPECT and GBP scan were in poor agreement. CONCLUSION: The estimates of EF by g-TI-SPECT was well correlated with those by GBP scan. However, EF of g-TI-SPECT doesn't agree with EF of GBP scan. EF of g-TI-SPECT cant be used interchangeably with EF of GBP scan.
Perfusion* ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Irbersatan, an orally active antihypertensive agent, effectively reduce blood pressure by directly blocking angiotensin II receptors without any significant adverse effects. The purpose of this study is to evaluate the efficacy and safety of irbesartan in patients with mild to moderate hypertension. METHODS: This study enrolled 83 patients who had diastolic pressure above 95 mmHg and below 110 mmHg on two measurements. Sixty eight patients were administered 150mg of irbesartan, an angiotensin II receptor blocker, daily for four weeks as an initial dosage. If the sitting diastolic pressure was equal to or greater than 90 mmHg after a 4 week treatment period, the dosage was doubled until the end of 8 weeks. Baseline pressures, antihypertensive effect, side effects, laboratory findings were compared before and after treatment. RESULTS: Fourty two patients out of 53 patients having completed this study showed decreased blood pressure equal to or more than 5 mmHg of the sitting diastolic pressure (response rate=79%). Twenty one patients out of 53 patients showed normalized blood pressure below 90 mmHg of the sitting diastolic pressure (normalization rate=40%). The extent of decrease in diastolic and systolic blood pressure after eight week treatment was an average 11.7+/-10.1 mmHg and 16.3+/-18.9 mmHg, respectively (p<0.05). Nineteen ontoward side effects was observed in 17 patients out of 68 patients with medication (frequency of ontoward effects=25%). Only one case with headache was considered to be related to the medication. Abnormal laboratory findings were observed in eight patients, and only one case with elevation of bilirubin and ALT levels was considered to be related to the medication. CONCLUSION: In conclusion, irbesartan is a safe and effective antihypertensive drug in patients with mild to moderate hypertension with tolerable side effects.
Bilirubin ; Blood Pressure ; Headache ; Humans ; Hypertension* ; Receptors, Angiotensin

No abstract available.
Angioplasty* ; Budd-Chiari Syndrome* ; Heart Ventricles* ; Stents*

BACKGROUND AND OBJECTIVES: The pathological findings of Non-Q wave myocardial infarction(NQMI) on ECG did not always correspond to subendocardial infarction(SEMI). The purpose of this study was to evaluate the diagnostic validity of ECG for SEMI by myocardial contrast echocardiography (MCE) in the patients with acute myocardial infarction(AMI). MATERIALS AND METHODS: The study population was 84 patients who underwent MCE under the diagnosis of AMI. MCE was performed by intracoronary injection of sonicated Hexabrix into the infarct related artery and SEMI was diagnosed by inspecting endocardial defect with epicardial enhancement on MCE. RESULTS: (1) Among 19 NQMI cases, 7 cases showed SEMI with MCE score 0.5, 11 cases with score 1, and 1 case with score 0. Among 65 Q-wave MI(QMI) cases, only 5 cases showed SEMI. (2) 7 cases who had NQMI with SEMI showed LV wall motion recovery at follow-up echocardiography except 1 case. Whereas, of 5 QMI cases who had SEMI, only 1 case improve LV wall motion. CONCLUSION: NQMI on ECG does not always imply SEMI on MCE, but the absence of pathologic Q wave in the patients with SEMI is thought to be a predictive factor of the recovery of LV wall motion.
Arteries ; Diagnosis ; Echocardiography* ; Electrocardiography* ; Follow-Up Studies ; Humans ; Infarction* ; Ioxaglic Acid