Differential diagnosis of pelvic masses with serum CA-125, ultrasound, and positron emission tomography / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate whether positron emission tomography (PET) is more valid than transvaginal ultrasonography (TVS) or serum CA125 in differentiating malignant ovarian tumor from benign ovarian tumor. METHODS: Fifty patients with adnexal tumor were evaluated with PET, TVS and serum CA 125 before surgery. PET was used to determine the uptake of FDG (18F-2-fluoro-2-deoxyglucose) for characterization of ovarian tumor. Sassone score was used as sonomorphological scoring system to distinguish from malignant to benign lesion. This scoring system is based on ovarian inner wall structure, wall thickness, septation, and echogenicity. Serum CA-125 levels were measured. After surgery, based on histopathologic findings, sensitivity, specificity, accuracy of each diagnostic modality at each cut-off value were calculated. And the validity of three diagnostic modalities was analysed further with receiver operating characteristics (ROC) curve. RESULTS: In the sonographic evaluation of adnexal tumors, the sensitivity and specificity were 63% and 76% at the cut off level of 9 of Sassone score. With PET, both sensitivity and specificity was not improved respectively. The ROC curves show that PET does not provide statistically significant benefits to predict ovarian malignancy. CONCLUSION: Our results suggested that CA-125 has no statistical significance and PET did not provide more significant additional diagnostic information than TVS for differentiation of malignant ovarian tumor from benign ovarian tumor.

Clinical significance of serum prealbumin in gynecologic malignancy / 대한산부인과학회지

OBJECTIVE: The prognosis of gynecologic malignancies was closely related to the nutritional status of patients as well as clinical or surgical staing at the time of diagnosis. The serum prealbumin has relatively short half-life among the nutritional parameters and could be used to detect immediate postoperative change of nutritional state in surgical patients. The purpose of this study was to evaluate the clinical impact of serum prealbumin and the validity of prealbumin in prediction and detection of postoperative complications in high risk patients with gynecologic malignancy. METHODS: 153 gynecologic malignant patients and 68 non-malignant patients operated from January 1999 to May 2003 were studied retrospectively. The serum albumin, total lymphocyte count (TLC), prealbumin were compared between the malignant and non-malignant patients, early and advanced stage cancer group, and complicated and uncomplicated group. Prealbumin was defined as the difference between preoperative and postoperative prealbumin concentrations. The correlation was statistically analyzed by Student's t-test, one way ANOVA test, and x2-test (SPSS ver. 11.0). RESULTS: There was significant difference in prealbumin between non-malignant patients and malignant patients (p=0.049). There was also significant difference in prealbumin between carcinoma in situ of uterine cervix and cervical cancer group (p=0.049). However there were no significant differences in prealbumin between early and advanced stage ovarian cancer and uterine cancer (p=0.48, p=0.67, respectively). There were no significant differneces between complicated and uncomplicated groups in prealbumin and delta prealbumin. CONCLUSION: Serum prealbumin was not useful in prediction and detection of high risk group of postoperative complications in gynecologic cancer patients.

Comparison of Outcomes between Burch Colposuspension with and without Concomitant Abdominal Hysterectomy

A total abdominal hysterectomy may cause a postoperative vesicourethral dysfunction due to an injury to the pelvic nerves. However, many incontinent women with benign diseases of the uterus and its adnexae have undergone a Burch colposuspension with a concomitant abdominal hysterectomy. This study was undertaken to compare the outcomes of a Burch colposuspension performed alone with that of a Burch with a concomitant abdominal hysterectomy. This study included 132 women, who, were treated for primary urinary incontinence from February 1999 to February 2002 and were diagnosed with stress urinary incontinence by means of the urodynamic test at the Department of Obstetrics and Gynecology at Yonsei University Hospital. Forty-two women underwent a Burch colposuspension alone (Burch group) and 90 women underwent a Burch colposuspension with a concomitant abdominal hysterectomy (hysterectomy group). Between the Burch and hysterectomy groups, the mean age, parity, menopausal rate, Hormone Replacement Therapy (HRT) rate, 1 year follow-up outcomes and postoperative complications were compared using the subjective and objective stress tests according to the retrospective chart review. The mean age (54.6 +/- 0.5 vs 58.6 +/- 9.2 years, p=0.382), parity (3.3 +/- 1.2 vs 3.6 +/- 1.7), menopausal rate (71.4 vs 77.7%), or HRT rate (23.3 vs 11.2%) of the two groups were similar. Complications related to surgery were encountered in 5 patients (11.9%) in the Burch group and in 7 patients (7.8%) in the hysterectomy group (p=0.842). One year follow-up subjective symptoms were encounterd in 2 patients in the Burch group and in 4 patients in the hysterectomy group (p=1.00). The stress test was positive in only one patient in the hysterectomy (p=1.00). No significant difference was observed in the 1 year follow-up outcomes, which were 91.4% (32/35 patients) in the Burch and 91.2% (73/80) in the hysterectomy groups. The results showed that there were no adverse effects on the 1 year follow-up outcomes or complications in patients who underwent a Burch colposuspension with an abdominal hysterectomy.

Evaluation of Nutritional Parameters in Gynecologic Patients Undergoing Laparotomic Surgery / 대한산부인과학회잡지

OBJECTIVE: The serum prealbumin has relatively short half-life among the nutritional parameters and therefore could be used to detect immediate postoperative change of nutritional state in surgical patients. This study was proposed to evaluate the validity of delta prealbumin in prediction and detection of high risk patients through the analysis of the correlation between delta prealbumin and postoperative complication. METHODS AND MATERIALS: One hundred sixteen patients were retrospectively studied. The serum albumin, TLC, prealbumin were compared between the complicated (N=30) and controlled group (N=86). The correlation between delta prealbumin and postoperative complication, underlying disease, malignancy and operative procedures were statistically analyzed by Student's t-test. RESULTS: There were no significant differences in serum albumin, TLC, prealbumin between the complicted and controlled group but there was a significant difference in delta prealbumin (98.5+/-50.9 vs 75.2+/-37.3 mg/dL, p=0.03). The associations were found between delta prealbumin and underlying disease, malignancy and operative procedures. However, it was not statistically significant. CONCLUSION: This study demonstrates that the surgical patients with high risk of postoperative complications can be detected early in immediate postoperative period by nutritional assessment as well as in preoperative period and can be supported enterally or parenterally. The evaluation of delta prealbumin will contribute to the decrease of postoperative morbidity and mortality.

A case of vaginal delivery in woman with congenital factor V deficiency / 대한산부인과학회잡지

Congenital factor V deficiency is a rare coagulation disorder, which is genetically autosomal recessive. In 1947, Owren first described a case of parahemophilia. During childhood, ecchymosis (bruising), epistaxis, oral hemorrhage, soft-tissue hemorrhage, and postpartum hemorrhage are noted in half of the patients. Because factor V is involved in common pathway in the coagulation scheme, prothrombin time (PT) and partial thromboplastin time (PTT) are prolonged. Definite diagnosis can be made with a specific factor V assay. Fresh frozen plasma would appear to be the treatment of choice. For the first time in Korea, we experienced a case of vaginal delivery in a patient with factor V deficiency. She delivered a male baby weighing 3120gm with median episiotomy. Six units of fresh frozen plasma were transfused during delivery. After additional transfusions of fresh frozen plasma, she was discharged on fourth postpartum day without hemorrhage or hematoma.

Content Analysis of Quality Nursing Care Perceived by Nurses / 간호학회지

PURPOSE: This study was designed to explore the perceptions of quality nursing care among nurses. METHOD: The data were analyzed using content analysis. The data were collected from 19 nurses who worked at diverse clinical areas in 8 general and university hospitals with over 400 beds. RESULT: 1. The attributes of quality nursing care were categorized into 7 hierarchies in the order of 'caring' (40.65%), 'specialty' (29.03%), 'nurse attainments' (15.48%), 'patient- centered nursing management' (6.45%), 'sincerity' (5.16%), 'kindness' (2.58%), 'satisfaction' (0.65%). 2. The concept of quality nursing care were defined as 'giving a satisfaction both to patients and nurses through patient-centered nursing management with specialty and caring in the ground of the kindness and sincerity'. CONCLUSION: Based on there findings, we suggest that the study results should be used for development of a quality assurance tool in nursing practice, patient care in hospital setting, education of nurses and nursing students. In addition, further repeated studies need to be conducted.

Survey on the Side Effects of the Vesicant Chemotherapy / 기본간호학회지

The purpose of this study was to identify side effects of the vesicant chemotherapy. The study was designed to be a descriptive survey. The subjects of this study were 88 patients with various types of cancer, primary lung cancer(25.0%), advanced gastric cancer(25.0%), breast cancer(20.5%), etc. The mean age was 44.8 years old(range: 16-68). The questionnaire was completed by nurses of the outpatient unit and chemotherapy ward, and intravenous nurse specialist. The results of the study were as follows: 1) Chemotherapy was administered with a 23G scalp needle and 24G insyte. Injection site was dorsum of hands (64.7%), cephalic vein(19.3%). Successful rate for the first attempt was 88.6%. The first & second cycle chemotherapy was 29.5% each.. Mainly used drugs were Navelbine(34.1%), Adriamycin(20.5%). 2) Venous problems after chemotherapy were pain(13.6%) incurred by venous, mainly due to the administration of Navelbine; redness at the inravenous site(12.5%) and itching sense 2.3%. Non-venous problems were nausea (18.2%), dullness(14.8%), vomiting(8.0%), facial flushing(6.8%), anxiety(5.7%). Subjective discomforts after chemotherapy were generalized arm pain at the injection side(14.8%), dizziness(6.8%), weakness(5.7%) and general bodyache (5.7%). Systemic anaphylactic reaction and extravasation did not occur. 3) Non-venous problem after chemotherapy were nausea, vomiting & anorexia. Frequency of chemotherapy related to side effects were itching, facial flushing, and nausea(p<0.05). Day of chemothe-rapy related to side effects were nausea & vomiting(p<0.05). Site of chemothe- rapy related to side effects were redness(p<0.05). Frequency of venipuncture related to side effects were redness(p<0.05). Conclusively, cancer chemotherapy patients have had some venous problem. They need appropriate venous access devices for chemotherapy. And other non-venous problem will be managed appropriately. Further research was required to identify the rate of venous complication or side effects of vesicant chemotherapy.

Analysis of the Nursing Interventions done by MICU and SICU nurses using NIC / 간호학회지

The purpose of this research was to identify nursing interventions performed by MICU and SICU nurses. For data collection this study used the taxonomy of the Nursing Interventions Classification(NIC: 433 nursing interventions) which was modified by McCloskey and Bulecheck(1996). Each of the 433 interventions were identified as used by MICU and SICU nurses. More than 50% of the ICU nurses performed 280 nursing interventions at least monthly. Rarely used interventions included 26 nursing interventions in the childbearing care class. Overall, both MICU and SICU nurses used interventions in the Physicological : Complex domain most often on a daily basis and the interventions in the Family domain least often. The most frequently reported interventions as being used daily in the MICU were chest physioterapy, airway suctioning and coughing enhancement and, in the SICU, documentation and airway suctioning. There were significant differences between MICU and SICU nurses differences interventions childbearing care, cognitive therapy, communication enhancement, coping assistance, elimination management, lifespan care, health system mediation, immobility management, medication management, neurologic management, patient education psychological comfort promotion, physical comfort program, respiratory management, risk management and information management. The SICU nurses performed there interventions more frequently than the MICU nurses. These findings will help in building of a standardized language for the MICU and SICU and enhance the quality of nursing care.