Determination of Subjective Relaxation Effects of a Hospital Rooftop Forest on Healthcare Workers / 日本温泉気候物理医学会雑誌

Purpose   The purpose of this study was to determine the relaxing effects of a hospital rooftop forest on healthcare workers and to assess the influence of trait anxiety. Methods   Sixteen male workers (aged 37.1±10.6years, mean±SD) and 56 female workers (aged 43.5±11.2years) participated in this study. Females were divided into 32low-to medium-anxiety and high-anxiety groups according to their trait anxiety as per the State Trait Anxiety Inventory-Form JYZ (STAI-Form JYZ). The experimental site was a rooftop forest, which covered an area of 122 m2, on the fourth storey of a health service facility. An outdoor car park area of 170m2, near the same facility, was used as a control. All participants were assessed individually at 3 sites: pre-room, rooftop forest, and outdoor car park area. Participants sat still in a wheelchair and viewed the scenery for 5minutes in each experimental area. The subjective effect was analyzed using the state anxiety as per the STAI-Form JYZ and the Profile of Mood States (POMS). The data between the rooftop forest and the control was compared within each participant. The participants were also divided into sex- and age-matched groups: A and B. Group A moved to the rooftop forest from the pre-room and group B first moved to the control area to eliminate the order effect. Results and Discussion   After viewing the rooftop forest, the mean values of state anxiety as per the STAY-Form JYZ showed a significant (p<0.01) decrease to 34.6±8.1 (43.4±8.4for control) in males and to 36.3±10.2 (45.8±8.8) in females. In low- to medium-anxiety females, state anxiety significantly (p<0.01) decreased to a“very low”anxiety state (“low” for control), and in high-anxiety females, it significantly (p<0.01) decreased to a “low” anxiety state (“intermediate” for control). As per the T-score of POMS, in males, “Fatigue” significantly (p<0.01) decreased to 39.0±7.5 (41.1±7.0) and “Vigor” significantly (p<0.01) increased to 43.3±10.4 (37.9±8.1). In females, “Tension-Anxiety” significantly (p<0.01) decreased to 39.7±7.7 (43.7±8.8), “Depression-Dejection” significantly (p<0.01) decreased to 43.5±6.3 (45.4±7.6), “Fatigue” significantly (p<0.01) decreased to 40.7±7.3 (43.6±8.5), and “Vigor” significantly (p<0.01) increased to 46.2±10.8 (38.9±8.0). After viewing the rooftop forest, the “iceberg profile” observed in the visual pattern of low- to medium-anxiety females indicated positive feelings. The “negative wing” indicating negative feelings observed in high-anxiety females in the pre-room disappeared after viewing the rooftop forest. Conclusion   We demonstrated that a short exposure to a rooftop forest environment induces a significant subjective relaxation effect in healthcare workers and that this effect is influenced by individual trait anxiety.

Determination of Subjective Relaxation Effects of a Hospital Rooftop Forest on Healthcare Workers / 日本温泉気候物理医学会雑誌

<B>Purpose</B><BR>  The purpose of this study was to determine the relaxing effects of a hospital rooftop forest on healthcare workers and to assess the influence of trait anxiety.<BR><B>Methods</B><BR>  Sixteen male workers (aged 37.1±10.6years, mean±SD) and 56 female workers (aged 43.5±11.2years) participated in this study. Females were divided into 32low-to medium-anxiety and high-anxiety groups according to their trait anxiety as per the State Trait Anxiety Inventory-Form JYZ (STAI-Form JYZ). The experimental site was a rooftop forest, which covered an area of 122 m<SUP>2</SUP>, on the fourth storey of a health service facility. An outdoor car park area of 170m<SUP>2</SUP>, near the same facility, was used as a control. All participants were assessed individually at 3 sites: pre-room, rooftop forest, and outdoor car park area. Participants sat still in a wheelchair and viewed the scenery for 5minutes in each experimental area. The subjective effect was analyzed using the state anxiety as per the STAI-Form JYZ and the Profile of Mood States (POMS). The data between the rooftop forest and the control was compared within each participant. The participants were also divided into sex- and age-matched groups: A and B. Group A moved to the rooftop forest from the pre-room and group B first moved to the control area to eliminate the order effect.<BR><B>Results and Discussion</B><BR>  After viewing the rooftop forest, the mean values of state anxiety as per the STAY-Form JYZ showed a significant (<I>p</I><0.01) decrease to 34.6±8.1 (43.4±8.4for control) in males and to 36.3±10.2 (45.8±8.8) in females. In low- to medium-anxiety females, state anxiety significantly (<I>p</I><0.01) decreased to a“very low”anxiety state (“low” for control), and in high-anxiety females, it significantly (<I>p</I><0.01) decreased to a “low” anxiety state (“intermediate” for control). As per the T-score of POMS, in males, “Fatigue” significantly (<I>p</I><0.01) decreased to 39.0±7.5 (41.1±7.0) and “Vigor” significantly (<I>p</I><0.01) increased to 43.3±10.4 (37.9±8.1). In females, “Tension-Anxiety” significantly (<I>p</I><0.01) decreased to 39.7±7.7 (43.7±8.8), “Depression-Dejection” significantly (<I>p</I><0.01) decreased to 43.5±6.3 (45.4±7.6), “Fatigue” significantly (<I>p</I><0.01) decreased to 40.7±7.3 (43.6±8.5), and “Vigor” significantly (<I>p</I><0.01) increased to 46.2±10.8 (38.9±8.0). After viewing the rooftop forest, the “iceberg profile” observed in the visual pattern of low- to medium-anxiety females indicated positive feelings. The “negative wing” indicating negative feelings observed in high-anxiety females in the pre-room disappeared after viewing the rooftop forest.<BR><B>Conclusion</B><BR>  We demonstrated that a short exposure to a rooftop forest environment induces a significant subjective relaxation effect in healthcare workers and that this effect is influenced by individual trait anxiety.

Effects of Rooftop Forest-like Field on Elderly People Requiring Care / 日本温泉気候物理医学会雑誌

<B>Purpose</B><BR>  The purpose of this study is to clarify the impressions that elderly people requiring care have when exposed to a “rooftop forest-like field.”<BR><B>Methods</B><BR><B>Experimental sites</B> : (1) The rooftop forest-like area: It covers an area of 122 m<SUP>2</SUP> on the 3rd story rooftop of a health service facility. It has 140 cm undulations, and a murmuring stream 7 m long and 58 cm deep flowing through the center. Fifty-one species of trees and 33 species of weeds, herbs, and grasses have been planted. Nearby is a mountain from which some birds come to the area. This mountain formed the background to this landscape. (2) The outdoor parking area: Control area was an area of 170 m<SUP>2</SUP> next to the same facility. Cars were prevented from entering during the study.<BR><B>Subjects:</B>The subjects were 30 females aged from 71 to 95 (mean ± SD: 81.7 ± 5.6). They were residents of the facility or attended to the facility for day care. They were divided into two groups, A and B, consisting of 15 females each. The groups were matched for age and cerebral vascular disorders (CVD). No patients with dementia were included. <B>Experimental design</B> : On the first day of The experiment, group A was sent to the rooftop forest-like area, and group B was sent to the open-air parking area. On the second day, each group went to the other area to eliminate the order effect. The subjective impression was measured using the semantic differential (SD) method. Patients sat still in a wheelchair and watched the scenery for 7 minutes and then answered the questionnaire.<BR><B>Results and Discussion</B><BR>  The rooftop forest-like field was perceived as a “beautiful,” “refreshing,” “orderly,” “enjoyable,” “comfortable” “secure,” “healthy,” “calm,” “soothing,” “friendly,” “quiet,” and a “holy” area. It was similar to the impression made by natural coniferous forests or natural rice fields. More than 80% of subjects expressed subjective relaxed state, as “most enjoyable,” “most comfortable,” and “most secure” as their impressions of the rooftop forest-like area. The impression of rooftop forest like area was characterized by high scores for both space and sensory factors using the SD method. Compared with previous reports, this forest-like area may have a relaxing effect on elderly people requiring care which is subjectively perceived.<BR><B>Conclusion</B><BR>  It was demonstrated that the rooftop forest-like field was perceived as a “comfortable”, “healthy”, and “relaxing” space by elderly people requiring care.

Reconstruction of the Face Using Thoracodorsal Artery Perforator Free Flap after Resection of Arteriovenous Malformation

PURPOSE: The treatment of arteriovenous malformation (AVM) of the face remains a difficult challenge in plastic surgery. Incomplete resection resulting in uncontrolled bleeding, postoperative enlargement of the remaining malformation, and a poor functional and cosmetic result could be the problems confronted by the surgeons. METHODS: A 37 year-old male with large arteriovenous malformation in face treated with preoperative superselective transarterial embolization and free flap transfer. The size of the defect was 13 x 9 cm. Sclerotheraphy without resection were performed several times but the results were unsatisfactory. Resection was performed the next day of embolization. We were able to repair with the thoracodorsal artery perforator free flap. And facial muscle reconstruction performed by simultaneous muscle and nerve transfer. RESULTS: During the follow-up period 8 months the patient regained an acceptable cosmetic appearance. And he has shown no reexpansion of the malformation. CONCLUSION: The thoracodorsal artery perforator free flap could be a good choice for the reconstruction for massive defects of the face. A huge arteriovenous malformation could be safely removed and successfully reconstructed by the complete embolization, wide excision and coverage with a well vascularized tissue.

Intraosseous Hemangioma of the Zygoma and Its Management

PURPOSE: Intraosseous hemangiomas are rare and account for fewer than 1% of all bone tumors. The site that is most commonly involved are the vertebral column and the skull. Within the facial skeleton, hemangiomas can occur in the mandible, maxilla, the nasal bones, and rarely the zygoma. METHODS: We report a case of an intraosseous hemangioma of the zygoma in a 49-year-old male. The patient had a slow growing hard mass in the left zygoma, which had been present for 8 years. Other than the cosmetic deformity, the patient experienced no pain and did not have any problem. He had no history of trauma in that area and no ocular symptoms. Preoperative computed tomography showed a trabeculated mass arising from the body of the left zygoma. The mass was surgically removed without having to reconstruct the bone defect by spairing the inner cortex. RESULTS: Histopatholgical examination indicated a cavernous hemangioma. After 4 months of follow up, no functional and cosmetic impairment was identified. The patient was satisfied with the result. CONCLUSION: An intraosseous hemangioma of the zygoma can be treated with total surgical excision with preservation of the inner cortex, thus eliminating the need for reconstruction of bone defect.

Estrogen Producing Adrenocortical Carcinoma / 대한비뇨기과학회지

An estrogen producing adrenocortical carcinoma is a rare, highly malignant tumor. Fewer than 100 cases of feminizing adrenocortical carcinomas in men have been reported. These tumors are usually large in size and show high levels of serum total estrogen and estradiol. Recently, two cases of estrogen producing adrenocortical carcinoma were experienced by our selves during in year. A unilateral adrenalectomy, with mass excision, was performed in both patients, with an ipsilateral nephrectomy performed in just one. Mitotane or cisplatin based adjuvant chemotherapy was also performed.

Prognostic Significance of Prostate-specific Antigen Level Two Months after Maximal Androgen Blockade in Metastatic Prostate Cancer / 대한비뇨기과학회지

PURPOSE: The aim of this study was to analyze the prognostic significance of pre- and post-treatment serum prostate-specific antigen (PSA) level, together with a variety of other clinicopathological parameters, in patients with metastatic prostate cancer receiving maximal androgen blockade (MAB). MATERIALS AND METHODS: The PSA levels before and during MAB, together with various clinicopathological parameters, were measured in 65 patients with newly diagnosed metastatic prostate cancer. The prognostic significance of these parameters, including the PSA level two and six months after MAB (PSA2MO and PSA6MO), a 50% reduction in the pretreatment PSA level after MAB (PSA50), the extent of disease (EOD), performance state, Gleason score and pretreatment hemoglobin, were analyzed by both univariate and multivariate tests. RESULTS: Of the forty-nine patients with a pretreatment PSA level of > or =50ng/ml, twenty-four (24/49, 48.9%) showed normalized ( or =50ng/ml, patients with a normalized PSA2MO showed a higher survival rate than those with a non-normalized PSA2MO from the univariate analysis using the Log-Rank test (p=0.0001), and PSA2MO was revealed as the most useful prognostic factor (p=0.022) from the multivariate analysis using the Cox proportional hazards regression model. CONCLUSIONS: A normalized ( or =50ng/ml.

Sonographic Evaluation of Breast Nodules: Comparison of Conventional, Real-Time Compound, and Pulse-Inversion Harmonic Images

OBJECTICE: To compare the use of conventional, real-time compound, and pulse-inversion harmonic imaging in the evaluation of breast nodules. MATERIALS AND METHODS: Fifty-two breast nodules were included in this study, conducted between May and December 2000, in which conventional, real-time compound, and pulse-inversion harmonic images were obtained in the same plane. Three radiologists, each blinded to the interpretations of the other two, evaluated the findings, characterizing the lesions and ranking the three techniques from grade 1, the worst, to grade 3, the best. Lesion conspicuity was assessed, and lesions were also characterized in terms of their margin, clarity of internal echotexture, and clarity of posterior echo pattern. The three techniques were compared using Friedman's test, and interobserver agreement in image interpretation was assessed by means of the intraclass correlation coefficient. RESULTS: With regard to lesion conspicuity, margin, and internal echotexture of the nodules, real-time compound imaging was the best technique (p < 0.05); in terms of posterior echo pattern, the best was pulse-inversion harmonic imaging (p < 0.05). Real-time compound and pulse inversion harmonic imaging were better than conventional sonography in all evaluative aspects. Interobserver agreement was greater than moderate. CONCLUSION: Real-time compound and pulse-inversion harmonic imaging procedures are superior to conventional sonography in terms of both lesion conspicuity and the further characterization of breast nodules. Real-time compound imaging is the best technique for evaluation of the margin and internal echotexture of nodules, while pulse-inversion harmonic imaging is very effective for the evaluation of the posterior echo patterns.

Spiral CT Findings of Chromophobe Renal Cell Carcinoma: Correlation with Pathologic Features and Prognosis

PURPOSE: To describe the spiral CT findings of CRCC and to correlate these with the pathologic features, nuclear grading, tumor staging, and prognosis. MATERIALS AND METHODS: We encountered eleven cases of CRCC among 167 cases of histopathologically proven RCC, retrospectively evaluating the spiral CT findings of CRCC including tumor size, internal texture, attenuation, margin, and the involvement of veins or lymph nodes. In addition, the CT findings were correlated with the pathologic features, Fuhrman's nuclear grade, Robson's staging, and the prognosis. Between 27 and 80 (mean, 49.6) months later, the follow-up CT scans of tea patients were examined for tumor recurrence. RESULTS: All tumors, which ranged in size from 2.5 to 15 (mean, 7.7) cm, were solid and well demarcated from renal parenchyma. Pre-contrast CT scans showed that their attenuation was equal to (n=1) or slightly lower (n=10) than that of renal parenchyma, and on early and delayed phase post-contrast enhanced scans, attenuation was low in all cases. In three, focal areas in which attenuation was lower than in the rest of the tumor were observed; histopathologically, these represented hyalinization. There was neither venous nor lymph node involvement, and no distant metastasis. Histopathologic examination demonstrated cystic change (n=1), hemorrhage or necrosis (n=5), complete encapsulation (n=3) and perirenal fat infiltration (n=3). Nuclear grading was II (n=6) or III (n=5), and tumor staging was I (n=8) or II (n=3). Among the five cases in which the nuclear grade was III, three were stage I and two were stage II. Follow-up scans showed no evidence of tumor recurrence, and all patients survived. CONCLUSION: Pre-, early- and late-phase post-contrast enhonced spiral CT scans showed that the attenuation of a CRCC was lower than that of renal parenchyma. Even where the nuclear grade was higher, a well-demarcated soild mass was observed, the tumor stage was lower and the prognosis better.

Retroperitoneal Ancient Schwannoma / 대한비뇨기과학회지

The term 'ancient' schwannoma was proposed for a group of neural tumors showing degenerative changes and marked nuclear atypia. The findings from abdominal ultrasound and computed tomography, in a patient with a retroperitoneal ancient schwannoma, are presented, and the histological features of this unusual type of tumor are reviewed. The presence of a large, well-delineated complex cystic mass in the deep soft tissues should raise the possibility of an ancient schwannoma. The treatment of choice for an ancient schwannoma is complete excision. It is important to recognize these tumors as benign, with excellent prognosis, so as to avoid unnecessary radical surgery. A recurrence, or persistence, seems to be associated with incomplete resection, which occurred in 10% of the reported cases.

Preoperative CT Assessement of Esophageal Carcinoma: Comparison between the Patients with and without Recurrence of Esophageal Carcinoma after Surgical Resection

PURPOSE: To determine whether preoperative CT is helpful in predicting the development of recurrent tumor following surgical resection in patients with esophageal cancer. MATERIALS AND METHODS: Thirty patients with esophageal cancer in whom preoperative CT of the chest had been performed were included in the study. All had undergone esophagectomy, esophagogastrostomy and lymph node dissection at our institution between 1995 and 1997. They were divided into two groups according to the development of tumor recurrence during the follow-up period of three years. Sixteen patients (group I) suffered tumor recurrence, while the other 14 (group II) remained tumor-free after surgery. In each group, a review of the preoperative CT scans indicated the length, thickness, location and margin of the tumor, and the presence or absence of lymphadenopathy in the mediastinum and/or upper abdomen. Differences in preoperative CT findings between the two groups were assessed by statistical testing. RESULTS: Lymphadenopathy of the mediastinum and/or upper abdomen was seen in 11 (69%) of 16 patients in group I and three (21%) of 14 in group II (p.05). In group I, five esophageal tumors were located in the middle esophagus and eleven in the lower esophagus. In group II, such tumor was located one in the upper esophagus, six in the middle esophagus, and seven in the lower esophagus (p>.05). CONCLUSION: Patients with preoperative CT findings of lymphadenopathy and/or an indistinct primary tumor margin are more likely to develop tumor recurrence following surgical resection than those without these findings.

The Usefulness of Test Bolus Examination in Three-Dimensional Contrast-Enhanced MR Angiography of the Carotid Artery

PURPOSE: To compare the usefulness of test bolus examination in three-dimensional contrast enhanced MR angiography of the carotid artery with that of the fixed delay time method. MATERIALS AND METHODS: Sixty consecutive patients (mean age, 60.1 years) in whom carotid arterial disease was suspected and who were examined during a 17-month period were divided into two equal groups. For group A, a fixed delay time of 5 secs was used, while for group B, the delay time of the test bolus examination was calculated from the signal intensity versus time curve of the carotid artery, obtained after the test injection of 1 ml contrast material into the right brachal vein. Overall image quality, discrimination between the arterial and the venous phase, and the contrast-to-noise ratio(CNR) of the carotid artery were compared between the two groups. Overall image quality was classified as excellent, good, moderate or poor, and discrimination between the two phases was graded IV-I according to the degree of jugular venous enhancement. RESULTS: In group A, overall image quality of the carotid artery was classified as excellent or good in 13 (43.3%)and 9 (30.0%) cases, respectively, while in group B the corresponding figures were 23 (76.7%) and 5 (16.7%). The differences between the two groups were statistically significant (p<0.05). In terms of discrimination between the arterial and venous phase, 20 (66.7%) of the 30 cases in group A were assigned grade IV or III, while 28 (93.3%) of the 30 in group B were assigned these same grades (p<0.05). The CNR of the carotid artery was higher in group B(67.1 +/-16.1) than in group A(27.3 +/-17.8), with statistical significance(p<0.05). CONCLUSION: For examination of the carotid artery, contrast enhanced MR angiography using a test bolus is su-perior to the fixed delay time method.

Recovery of Motion Fraction and Shoulder Function ofter Operative Treatment of Shoulder Instability / 대한정형외과학회잡지

PURPOSE: We expected the motion fraction could be checked, with simple radiographic examination, according to the guide-line of fluoroscopic technique, and recovery of the function also could be correlated with the improvement of the motion fraction. MATERIALS AND METHODS: We measured the motion fraction of the glenohumeral and scapulothoracic movement using fluoroscope in 30-degree intervals of arm elevation in the scapular plane. The ratio of glenohumeral to scapulothoracic movement (thetaGH/thetaST) was 1.6 for the full range of motion in scapular plane. During arm elevation, scapular tilting from the coronal plane was decreased from 42 degrees to 20 degrees tilting as well as internal rotation (scapular extension). We also measured the motion fraction (thetaGH/thetaST) and functional recovery of the shoulder in 11 patients after operative treatment of the shoulder instability in 15 patients from December 1996 to August 1997. RESULTS: We could find out a significant correlation between the recovery of motion fraction and shoulder function. These results would be applied in planing rehabilitation program after treatment of the shoulder instability. CONCLUSIONS: The measuring technique of glenohumeral to scapulothoracic movement (thetaGH/thetaST) with fluoroscopy could be applied to the simple radiographic measurement at the out-patient clinic in order to identify the pathology and recovery of shoulder motion after treatment