The Relationship between Degree of Dysphagia and the Timing and Frequency of Videofluoroscopic Swallowing Studies in Patients with Acute Stroke / 대한연하장애학회지

OBJECTIVE: The aim of this study is to analyze relationships between dysphagia, and the timing and frequency of videofluoroscopic swallowing studies (VFSS) in patients with acute stroke. METHOD: We retrospectively reviewed the medical records of 111 patients with acute stroke whose dysphagia were evaluated by VFSS. The data were analyzed with descriptive statistics, t-test, and one-way ANOVA; Pearson correlation coefficient was also reported for all analyses. RESULT: Dysphagia was significantly different by transit time from stroke onset to arrival at the hospital (F=4.74, P=.011), paralysis site (F=3.05, P=.032), nasogastric tube (t=−3.81, P=.001), and diet just before the first VFSS (F=23.27, P<.001). VFSS timing was significantly different by smoking (t=2.88, P=.005), underlying disease (t=−3.58, P=.001), transit time from stroke onset to arrival at the hospital (F=5.90, P=.004), type of stroke (t=−5.24, P<.001), paralysis site (F=5.89, P=.001), nasogastric tube (t=−4.86, P=.001), surgery or angiography (t=−2.22, P=.032), level of consciousness (F=6.07, P=.000), length of stay (F=53.73, P=.001), department (F=16.37, P<.001), and diet just before the first VFSS (F=5.38, P=.006). VFSS frequency was significantly different by type of stroke (t=2.69, P=.008), nasogastric tube (t=−5.11, P=.001), length of stay (F=19.41, P=.001), department (F=7.18, P<.001), and the diet just before the first VFSS (F=16.67, P<.001). There was a significant correlation between dysphagia degree and the timing and frequency of VFSS. CONCLUSION: The more severe the degree of dysphagia, the longer the VFSS timing, and the greater VFSS frequency. The findings could be used for establishing systematic nursing care plans and active nursing intervention for dysphagia-related characteristics.

Importance-performance Analysis of Patients' and Nurses' perspectives on Rehabilitation Nursing Services / 재활간호학회지

PURPOSE: This study attempted to understand patients' and nurses' perspectives on the priority of rehabilitation nursing services using Importance-Performance Analysis (IPA). METHODS: This study used descriptive research design. Data were collected from 121 patients and 144 nurses using self-reported questionnaires. Statistical analysis included an independent t-test, analysis of variance (ANOVA), and IPA conducted using SPSS/WIN 21.0 version. RESULTS: There were no statistical differences between the patients' and nurses' mean scores on perceptions of the importance (t=-0.83, p=.409) and performance (t=-0.32, p=.751) of rehabilitation nursing services. The IPA matrix showed a difference between patients and nurses in terms of their perceived priority of nursing services. Regarding the perception of patients, "helping a patient to continue to practice bedside physiotherapy and occupational therapy", "providing information on the proper care agency and community resources", and "providing education for the prevention of complications" fell in the "concetrate here" area (2nd quadrant). CONCLUSION: The results showed that the priorities of patients and nurses did not match in terms of some of the rehabilitation nursing services. Thus, rehabilitation nursing services need to be provided based on the patients' needs. Allocation of resources for the service items that fell in the "concentrate here" area of the IPA need be reconsidered for the quality in nursing care.

Two Cases of Vivax Malaria Accompanied by Splenic Complications (such as splenic rupture and splenic infarction) / 감염과화학요법

Malaria is a protozoan disease transmitted by Anopheles mosquitoes. Since Plasmodium vivax malaria reemerged in the north west areas of South Korea in 1993, many cases with various manifestations have been reported. Clinicians should be aware of the rare and severe complications as well as the common complications. Splenic complications such as hematoma formation, rupture, torsion, cyst formation, and infarction are unusual manifestations of tertian malaria; therefore, we present two cases of P. vivax malaria with severe splenic complications with review of literature. One had a splenic infarction and the other had a splenic rupture, which was diagnosed by computed tomography. Both patients were successfully treated with a conservative approach.

A Case of 'True' Fungus-Infected Aneurysm of Abdominal Aorta in an Immunocompetent Patient / 감염과화학요법

Infected aneurysms are uncommon, frequently fatal lesions. "True" fungus-infected aneurysms are even rarer. Fungal infections have high morbidity and mortality. However, diagnosis is frequently difficult, since the symptoms are non-specific and standard diagnostic procedures are often insensitive. We experienced a patient with persistent fever and negative blood cultures. The patient was immunocompetent and had no risk factors, and was diagnosed with a fungus-infected aneurysm based on computed tomography and vascular surgery. The vascular tissue revealed some narrow-based budding yeast within the thrombus, suggesting Candida infection. Seventeen cases of infected aneurysm of the abdomen were reported in Korea from 1988 to 2007, although none were "true" fungus-infected aneurysms, making this the first fungus-infected aneurysm of the abdomen in Korea. Prompt diagnostic procedures and aggressive treatment modalities are necessary for patients with occult infection and negative blood cultures, regardless of their immunocompetence, because of the high morbidity and mortality of this condition.

Two Cases of Vivax Malaria Accompanied by Splenic Complications (such as splenic rupture and splenic infarction) / 감염과화학요법

Malaria is a protozoan disease transmitted by Anopheles mosquitoes. Since Plasmodium vivax malaria reemerged in the north west areas of South Korea in 1993, many cases with various manifestations have been reported. Clinicians should be aware of the rare and severe complications as well as the common complications. Splenic complications such as hematoma formation, rupture, torsion, cyst formation, and infarction are unusual manifestations of tertian malaria; therefore, we present two cases of P. vivax malaria with severe splenic complications with review of literature. One had a splenic infarction and the other had a splenic rupture, which was diagnosed by computed tomography. Both patients were successfully treated with a conservative approach.

A Case of 'True' Fungus-Infected Aneurysm of Abdominal Aorta in an Immunocompetent Patient / 감염과화학요법

Infected aneurysms are uncommon, frequently fatal lesions. "True" fungus-infected aneurysms are even rarer. Fungal infections have high morbidity and mortality. However, diagnosis is frequently difficult, since the symptoms are non-specific and standard diagnostic procedures are often insensitive. We experienced a patient with persistent fever and negative blood cultures. The patient was immunocompetent and had no risk factors, and was diagnosed with a fungus-infected aneurysm based on computed tomography and vascular surgery. The vascular tissue revealed some narrow-based budding yeast within the thrombus, suggesting Candida infection. Seventeen cases of infected aneurysm of the abdomen were reported in Korea from 1988 to 2007, although none were "true" fungus-infected aneurysms, making this the first fungus-infected aneurysm of the abdomen in Korea. Prompt diagnostic procedures and aggressive treatment modalities are necessary for patients with occult infection and negative blood cultures, regardless of their immunocompetence, because of the high morbidity and mortality of this condition.

Intraductal Ultrasonography for the Selection of Self Expandable Metal Stent in Extrahepatic Bile Duct Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: Endoscopic stent insertion with self expandable metal stent (SEMS) is one of the standard palliative treatments for the patients with unresectable bile duct carcinoma. The aim of this study was to determine whether detection of longitudinal spread of extrahepatic bile duct carcinoma by intraductal US (IDUS) would be helpful in the selection of metal stent for the palliative drainage in bile duct carcinoma. METHODS: Seventeen patients with histologically proven unresectable extrahepatic bile duct carcinoma who underwent endoscopic retrograde cholangiography with IDUS were included. Longitudinal cancer extension along the bile duct was determined and, then, compared with the cholangiographic image. The type and length of SEMS was selected based on IDUS findings. RESULTS: IDUS demonstrated more extensive tumor spread than ERC in 7 of 17 (41.2%) patients with the hepatic side of strictures and in 7 of 16 (43.8%) patients with the duodenal side of strictures. Five of 17 (29.4%) patients have changed the plan of endoscopic biliary drainage with SEMS after IDUS. There was no early dysfunction associated with endoscopic biliary drainage. CONCLUSIONS: IDUS prior to biliary drainage would be useful in demonstrating longitudinal extension of extrahepatic bile duct carcinoma. It has a potential role in helping stent selection and identifying factors which predict early stent dysfunction.