Details of Lymphedema, Upper Limb Morbidity, and Self Management in Women after Breast Cancer Treatment / 여성건강간호학회지

PURPOSE: To examine the details of lymphedema, upper limb morbidity, and its self management in women after breast cancer treatment. METHODS: Using a cross-sectional survey design, 81 women were recruited from a university hospital. Lymphedema was detected by a nurse as a 2-cm difference between arm circumferences at 6 different points on the arm. Degrees of pain, stiffness, and numbness were scored using a drawing of upper limb on a 0~10 point scale. Aggravating conditions and self-management for lymphedema were also recorded. RESULTS: The mean age of the participants was 52.5 years; the average time since breast surgery was 29.7 months. Histories of modified radical mastectomy (55%) and lymph node dissection (81%) were noted. Lymphedema was found in 59% of women, then pain and stiffness were prevalent most at upper arm while numbness was apparentat fingers, and the symptom distress scores ranged 3.9~6.7. Women experienced aggravated arm swelling after routine housework with greatly varied duration. Self-management was conservative with a wide range of times for the relief of symptoms. CONCLUSION: Lymphedema education for women with breast cancer should be incorporated into the oncologic nursing care system to prevent its occurrence and arm morbidity. Risk reduction guidelines, individually tailored self-care strategies, and self-awareness for early detection need to be refined in clinical nursing practices.

Comparison of the Characteristics of 16 Commercial Nebulizer/Compressor Combinations Used in Korea

PURPOSE: We assessed the dynamic characteristics of 16 nebulizer/compressor combinations currently available in Korea. METHODS: The 16 nebulizer/compressor combinations(Pariboy Type 38/Long life, Pariboy Type N/ Long life, Pariboy Type N/Salter 8900, Pariboy Type N/LC, Devilbiss pulmoaid-LT/Hudson, Devilbiss pulmoaid/Hudson, Mesmed neb-300/Own, San-up 3040/Hudson, Midas(Basic)/Own, AirJolie 2/ Hudson, Thomas 1127/Salter 8900, Noel NE-2000/Salter 8900, Omron CX3/Hudson, Chang Woo CWN-100/Salter 8900, Voyage/Mefar, Chang Woo ASI-Pro/Medel jet pulse) were evaluated in terms of particle size and mass output. In addition, we determined the effects of nebulizer fill volume on mass output. RESULTS: Pariboy Type N/Long life has the highest respirable mass of 0.184 mg/min and Mesmed Neb-300/Own has the lowest 0.019 mg/min. Pariboy Type N/Long life has the highest mass output of 0.68 mg/min and the shortest mass median aerodynamic diameter(MMAD) of 3.76 m. All combinations other than Pariboy Type N/Long life produced a MMAD of over 5 m. MMAD over a 5 min nebulization ranged 3.76 to 9.83 m. There were no significant effects of fill volume on mass output. CONCLUSIONS: We concluded that there is a wide variation in performance of nebulizer/compressor combinations. The characteristics of nebulizer/compressor combinations should be considered in selecting products.

A Case of Cerebral Hemorrhage with Congenital Arterio-Venous Malformation in a Newborn

Arteriovenous malformation(AVM) is the rare cause of neonatal intracranial hemorrhage. It is a congenital vascular lesion that can arising anywhere in the body. We report here on an unusual case of AVM in a full-term newborn infant who has no symptoms except enlarged bulging anterior fontanelle. AVM of other organs or adult cases were reported occasionally, but postoperative surviving intracranial AVM in a newborn infant has not been reported in Korea so far. The hematoma which was in the cortex of left temporal area, was removed surgically and the baby is living well under regular neurological check up.

The Impact of Fetal Echocardiography on the Treatment and Outcome of Congenital Heart Disease: Report of Fetal Diagnosis of Congenital Heart Disease in 2001 at CHA Hospital

PURPOSE: Prenatal diagnosis of congenital heart disease has been made by fetal echocardiography and its clinical impact on the outcome of CHD cases has been analysed. METHODS: A prospective study was performed for the fetal diagnosis of CHD for the standard risk pregnancy, confirmed postnatally or at second study and/or at autopsy and/or follow up at CHA hospital in 2001. Incidence of CHD has been calculated and compared to the incidence of CHD of the prescreening period(1992.3-1995.2). RESULTS: There were 66 cases of CHD prenatally during the study period. CHD consisted of 7 cases of ventricular septal defects(VSD), 7 cases of tetralogy of Fallot(TOF), 5 cases of heterotaxy, 5 cases of double outlet right ventricle(DORV), 5 cases of severe pulmonary stenosis(PS), 3 cases of hypoplastic left heart syndrome(HLHS), 3 cases of coarctation, 3 cases of critical aortic stenosis(AS), 3 cases of pulmonary atresia with intact ventricular septum(PA IVS). Among 66 fetal CHD cases, 30 cases of CHD has been terminated, 1 case died in utero and 23 cases has been delivered at cardiac center through planned delivery. The most common factors of termination were extracardiac and chromosomal anomaly. 17 cases of false negative diagnosis were small VSD and mild PS that couldn't be diagnosed in fetal stage. There was no false positive diagnosis. There were 30 cases of CHDs born in 2001 at CHA hospital. 28 cases were diagnosed postnatally. Among 30 cases of CHDs, there were 18 cases of VSD(17 small VSD), 6 cases of mild PS, 4 ASD, 1 PDA. Incidence rate of CHD in 2001 and period 1992.3-1995.2 were 5.95 and 10.15/1,000 livebirth respectively. CONCLUSION: The data suggested that all of the significant CHDs could be diagnosed prenatally accurately by fetal echocardiography. And the incidence rate of CHD has been decreased by 41.4%. And the most of the complex CHD has been transferred to the cardiac center for planned delivery or has been terminated. The rate of termination was 45.5%.

Enhanced Detection of Left Atrial Spontaneous Echo Contrast by Transthoracic Harmonic Imaging in Mitral Stenosis

BACKGROUND: Spontaneous echo contrast (SEC) of the left atrium (LA) is associated with increased risk of thromboembolism in patients with mitral stenosis(MS). The determination of the presence and severity of LA spontaneous echo contrast(SEC) is of prognostic importance in these patients. Harmonic imaging(HI), a novel echocardiographic technique that differs from conventional fundamental imaging(FI) by transmitting ultrasound at one frequency and receiving at twice the transmitted frequency, produces better endocardial border definition and myocardial opacification. However, there are no data about its value on the detection of LA SEC. The purpose of this study was to investigate the utility of transthoracic noncontrast HI in the detection of LA SEC in patients with. METHODS: Seventy-four consecutive patients with MS (49 female, mean age 51) underwent standard transthoracic echocardiograms (TTE) in both HI and FI and transesophageal echocardiography (TEE) to determine the presence and severity of LA SEC. LA SEC was graded by TEE; mild if only seen at high gain, severe if visible in the entire LA at normal gain control of the equipment. Control subjects comprised of 30 patients randomly selected from patients who did not have LA SEC at TEE examination. RESULTS: Atrial fibrillation was found in 46 patients (62.2%). The mean mitral valve area and mean mitral gradient were 1.0+/-0.3cm2 and 8.2+/-4.1mmHg, respectively. Nine patients (12.2%) had episodes of systemic embolism; stroke in 8 and peripheral embolism in 1. LA thrombus was found in 11 patients (14.9%) by TEE. LA SEC was present in all but one patient by TEE (mild in 35, severe in 38 patients). FI of TTE, however, revealed LA SEC in only 5 (6.8%) of the 73 patients. In contrast, in HI, LA SEC could be detected in 63 (86.3%) of the 73 patients. In the detection of severe LA SEC, the sensitivity of FI and HI were 13.2% (5/38) and 100% (38/38), respectively. LA SEC was not observed in control subjects either by FI or HI. CONCLUSION: Transthoracic HI significantly enhances the detection of LA SEC in patients with MS.

Real Time Determination of Left Atrial Volume by Automatic Boundary Detection: Comparison with Two-dimensional Echocardiographic Measurement

BACKGROUND: Echocardiographic automatic boundary detection(ABD) is a new on-line technique which automatically outlines the left atrial endocardial border and instantly calculates the left atrial area and volume from two dimensional echocardiographic images. To determine if left atrial volume can be derived using the ABD method, 70 patients with various etiology of heart disease(mean age 51) underwent complete echocardiographic examination with both the ABD method and conventional two-dimensional echocardiographic measurement. METHODS: End-systolic left atrial volume was obtained on-line from the apical four chamber view using ABD(ABD LAVOL). Left atrial length was also measured from an apical view. Left atrial volume was calculated using ellipsoid model(2D LAVOL) and method of disc(MANUAL LAVOL) by two-dimensional echocardiography. RESULTS: The end-systolic left atrial volume by ellipsoid model, method of disc and ABD were 87+/-31ml, 57+/-25 and 60+/-28ml, respectively. I.inear regression analysis revealed that the ABD LAVOL is closely correlated with 2D LAVOL and MANUAL LAVOL(ABD LAVOL vs 2D LAVOL, SEE=22ml, r=0.65, p<0.001; ABD LAVOL vs MANUAL LAVOL, SEE=6ml, r=0.97, p<0.001). CONCLUSIONS: ABD echocar-diography is a new on-line technique which may be used to accurately calculate left atrial volume in patients with various heart diseases.

A Case of Alagille Syndrome

Alagille syndrome is characterized by chronic cholestasis, posterior embryotoxon, skeletal abnormalities, cardiovascular abnormalities, and a typical face with prominent forehead and pointed chin. Its histological feature includes paucity of interlobular bile ducts. We experienced a 49-day-old female infant presenting with frequent upper respiratory tract infection and persistent jaundice. She had a typical face and chronic cholestasis. Echocardiograms revealed peripheral pulmonary stenosis. The histological examination of liver revealed paucity of interlobular bile ducts.

Magnetic Resonance Angiography in One Case of Hydraencephaly

In hydranencephaly, the cerebral hemispheres are absent or represented by membranous sacs with remnants of frontal, temporal or occipital cortex dispersed over the membrane. The brain stem is relatively intact. The cause of hydranencephaly is unknown, but bilateral occlusion of the internal carotid arteries during early fetal development can explain most of the pathologic abnormalities. We evaluated a case of hydranencephaly by magnetic resonance (MR) angiography. MR angiography shows both common, external carotid and vertebrobasilar arteries with no delineation of both internal carotid arteries from their origins. A brief review of the related literature was given on this subject.

Prognostic value of dobutamine echocardiography in prediction of late recovery of regional myocardial dysfuction in patients with acute myocardial infarction

BACKGROUND AND OBJECTIVES: Determining the presence of viable myocardium has prognostic and therapeutic implications in the treatment of acute myocardial infarction (AMI). The aim of this study was to assess the ability of dobutamine echocardiography (DE) to detect viable myocardium and predict the late improvement of regional left ventricular dysfunction after AMI. METHODS: Twenty-five patients (male 24, mean age 57+/-9.6) with AMI underwent DE (dobutamine: 0, 5, 10 and 20 microgramm/kg/min) in 4.8+/-2.2 days after infarction. Revascularization of infarct related artery was performed in 20 patients (percutaneous coronary angioplasty 18, coronary artery bypass graft surgery 2). A follow-up 2D-echocardiography was performed at 7.1+/-2.3 months after AMI. RESULTS: 1. Improvement of regional wall motion abnormality (RWMA) was observed in 12 patients during DE[DE (+) group]. Thirteen patients showed no improvement of RWMA[DE (-) group]. 2. In follow-up 2D-echocardiography 10 patients showed improvement of RWMA among DE (+) group (positive predictive value= 83.3%). Two patients showed improvement of RWMA among DE (-) group (negative predictive value=84.6%). Sensitivity and specificity of DE in predictiong late recovery of RWMA were 83.3% and 84.6% each. DE performed in the early stage of AMI seems to be useful in prediction of late recovery of regional left ventricular dysfunction.

Reduction of Left Ventricular Hypertrophy after Aortic Valve Replacement for Isolated Aortic Valve Stenosis

BACKGROUND: Residual left ventricular hypertrophy adversely aRects long-term outcome after aortic valve replacernent. Despite technical advances of increasing prosthesis orifice area, small valves implanted in the unenlarged aortic root may not be significantly less obstructive than the stenotic native valves they replace. METHOD: Forty patients receiving single aortic valve replacement for isolated aotic valve stenosis(without other valvular diseases and coronary artery diseases) were enrolled in this study. The operation was performed from Jan. 1990 to July 1996 in Yonsei Cardiovascular Center. They were implanted with 19, 21, 23, 25mm size valves. Twenty nine were men, and the mean age was 53.3+/-11.1 years(mean+standard deviation, range 27 to 70 years), and the follow-up duration was 29.5+/-19.5 months(range 12 to 86 months). Echocardiographic studies were performed before and more than 1 year after the operation. We reviewed the medical histories, clinical symptoms, and echocardiography. RESULTS: 1) The etiology of aotic valve stenosis were congenital bicuspid valve(18 cases, 45%), degenerative(9 cases, 23%), rheurnatic heart disease(8 cases, 20%), and others(5 cases, 13%). Clinical symptoms were dyspnea(39 cases, 98%), angina(19 cases, 45%), and sycope(3 case, 8%). The patients were divided into 19mm group(9 cases, 23%), 21mm group(16 cases, 40%), 23mm group(9 cases, 23%), and 25mm group(6 cases, 15%). The patients replaced with valves of smaller size had significantly smaller surface areas than those replaced with the larger valves. 2) The preoperative LV mass index of smaller valve groups was larger when compared to the larger valve groups. LV mass and mass index decreased in all four groups(albeit significantly in the 19 and 21mrn groups, and without significance in the 23 and 25mm groups). LVEDD, IVST, and PWT were significantly decreased in all four groups. 3) Postoperative peak and mean transvalvular pressure gradients were significantly decreased in all four groups, but were higher in 19mm group than others. Postoperative efFective valve area was significantly smaller in the 19mm group than other groups. 4) No significant differences were observed in left ventricular systolic function parameters both before and after the operation. Clinical symptoms improved in all groups after operation. 5) There was a significant negative correlation between the postoperative valve area index (VAI) and pressure gradients(PG=33.6 17.0xVAI, r=0.71, p<0.001). There was a significant reduction of the LV mass and LV mass index in the patients whose VAI was more than 0.7cm/m. CONCLUSION: In isolated aortic valvular stenosis, aortic valvular replacement produced reduction of left ventricular hypertrophy and clinical improvement. Although 19mm aortic prosthesis continued to create significant obstruction of the left ventricular outflow tract and a smaller effective valvular orifice, nevertheless improvement in LV hypertrophy and clinical symptoms occurred.