Behavioral problems in Korean children and adolescents with atopic dermatitis

Purpose@#Patients with atopic dermatitis (AD) experience a chronic relentless course which may affect emotional and behavioral problems. Moreover, AD could affect serious psychosocial problems due to its disfiguring skin conditions, particularly in adolescents who are under various stresses. The aim of this study was to investigate behavioral problems in children and adolescents with AD and to identify associated clinical factors. @*Methods@#A total of 69 subjects with AD were enrolled in this study. The severity of AD was assessed using the SCORAD (Scoring of Atopic Dermatitis) index and divided into 2 groups: mild-to-moderate and severe groups. Behavioral problems were assessed by using the Korean Child Behavior Checklist (K-CBCL). @*Results@#The severe AD group had higher total behavior problem scores and internalizing scores than the mild-to-moderate group. Social problem and attention problem scores were slightly higher in the severe AD group than in the mild-to-moderate AD group. The DSM (diagnostic and statistical manual of mental disorders)-anxiety, obsessive compulsive problems, and sluggish cognitive tempo problems were more frequently observed in the severe AD group. Longer disease duration was an independent risk factor of internalizing problems in subjects with AD. @*Conclusion@#This study showed that subjects with severe AD had higher total behavioral problem scores, particularly internalizing scales. Their behavioral problems may have poor compliance and consequently poor outcomes as well. Clinicians should be aware that children and adolescents with severe AD have more behavioral problems and that an interdisciplinary approach with medical and psychological supports is necessary for proper management.

How Well Can Matrix of Ferritin and Neutrophil to Lymphocyte Ratio Predict Metabolic Syndromein Korean Adults?

Background@#Previous studies have shown that elevated ferritin level and neutrophil to lymphocyte ratio (NLR) are risk factors of chronic low-gradeinflammation and contribute to the onset and progression of cardiovascular disease. In addition, metabolic syndrome has a similar relevance; thus,in this study, we aimed to determine how well metabolic syndrome could be predicted by measuring ferritin level and NLR. @*Methods@#From January 2016 to September 2018, 1,815 adults who underwent medical interviews, physical measurements, and blood tests at amedical examination center of a university hospital in Seoul were evaluated. Data were analyzed using the Spearman correlation analysis, anaverage comparison using analysis of variance, and a t test. The prevalence of metabolic syndrome was determined according to ferritin level andNLR. @*Results@#We found a significant correlation between the components of metabolic syndrome and ferritin level, but not NLR. The NLRs were divided intoquartiles for comparison with the mean values of the components of metabolic syndrome, but the results were not significant. A significantdifference was found only in ferritin level when we compared the mean values of ferritin level and NLR according to the presence or absence of ametabolic syndrome diagnosis. When ferritin level and NLR were considered simultaneously, the prevalence of metabolic syndrome tended tochange only when the ferritin level changed. @*Conclusion@#In healthy Korean adults, ferritin level, but not NLR, could be used as a predictor of metabolic syndrome.

Application of Relative Fat Mass Equation in Korean Adults

Background@#Body mass index (BMI) has limitations in determining body fat percentage and body fat distribution, and causes misclassification of body fat-defined obesity. As high body fat percentage is associated with mortality, an accurate assessment of body fat percentage is considered clinically important. Recently, Woolcott and Bergman reported a relative fat mass (RFM) equation which calculated the body fat percentage using the height and waist circumferences. However, as RFM has been studied only in European-, Mexican-, and African-Americans, an assessment in Asians was needed. Therefore, we aimed to evaluate the applicability of RFM in Korean adults. @*Methods@#This study included 7,733 adults who visited a Sanggye Paik Hospital Health Promotion Center from May 1, 2016 to November 12, 2018. BMI and RFM were calculated by measuring height, weight, and waist circumference. The total body fat (TBF) percentage was measured by bioelectrical impedance analysis. We compared the BMI, RFM, and TBF percentage to assess the applicability of RFM in Korean adults. @*Results@#RFM had a statistically significant correlation with TBF percentage in both male and female (male: β=0.808, R2=0.653, female: β=0.766, R2=0.587, P<0.001). In the Bland-Altman plot, RFM showed good agreement with the TBF percentage within the 95% confidence interval. @*Conclusion@#The RFM equation can be used to predict TBF percentage in Korean adults.

Retrospective anesthetic evaluation of non-obstetric surgery during pregnancy: single center experience

BACKGROUND: Laparoscopic procedures and ultrasonography are now commonly used in the obstetric field, and more non-obstetric procedures are being performed. However, little domestic data has been published on the topic. This present retrospective study investigated the clinical information and the effect on perinatal outcomes of non-obstetric surgery during pregnancy. METHODS: This retrospective study was performed using data of all adult pregnant women that underwent non-obstetric surgery at our institute between from July 2009 to December 2016. Data was collected from the institutional computerized database. The causes, types, and the gestational ages at surgery were collected as our primary outcomes. Basic characteristics of patients, operation times, anesthesia times, anesthetic methods, anesthetic agents, and adverse perinatal outcomes such as abortion or preterm delivery were evaluated as secondary outcomes. RESULTS: During the study period, there were 2,421 deliveries and 60 cases of non-obstetric surgery, an operation rate of 2.48%. The most common cause of non-obstetric surgery was abdominal surgery, followed by orthopedic surgery and neurosurgery. Most of abdominal surgeries were performed laparoscopically during the first trimester. The incidence of adverse perinatal outcomes was increased in the first trimester, was not related with anesthesia. CONCLUSIONS: The rate of non-obstetric surgery was found to be 2.48%, which was higher than those reported in previous domestic studies. This increase seems to have resulted from early diagnosis by ultrasonography and non-invasive surgery using laparoscopy. Adverse perinatal outcomes are not related with age, surgery and anesthetic-related factors but seem to be associated with surgery exposure stage, especially the first trimester.

Preliminary study of anesthetic risk factors in surgery for pathologic fractures secondary to metastatic tumors

BACKGROUND: Despite advances in the treatment of primary cancer, metastatic pathologic fractures still affect the survival of cancer patients. The goals of surgery, such as those with terminal cancer, are to maintain a maximum level of independence and improve the quality of life. A patient may be a poor surgical candidate because of a short life expectancy or illness that is too severe to benefit from surgical fixation. Moreover, this surgery is an operation accompanied with significant morbidity and mortality. This retrospective study investigated the characteristics of these patients and assessed the influence of anesthetic risk factors on the outcome. METHODS: The records of 45 patients with pathologic fractures who underwent surgical stabilization for metastatic factors from 1 January 1995 to 31 December 2013 at our hospital were reviewed. Demographic data, various severity scores, anesthetic factors, and survival were reviewed. RESULTS: The most common sites of primary tumors were lung, liver and stomach. The predominant sites of pathologic fractures were the femur (71.1%); six lesions were in the humerus and four in the spine. Univariate and multivariate analyses identified several prognostic factors with a significantly worse influence on survival, including lung tumor and Acute Physiology and Chronic Health Evaluation (APACHE) II score. CONCLUSIONS: Although the number of patients was too small to result in a satisfactory appraisal, the most important step is to select candidates to gain the benefits of palliative surgery. We suggest the possibility of APACHE II scoring and the recognition of lung cancer in making the clinical decision of performing the palliative osteosyntheses for patients with pathologic fractures.

Percutaneous mechanical lumbar disc decompression using the enSpire™ interventional discectomy system: a preliminary study

BACKGROUND: The enSpire™ interventional discectomy system is a new device for treating percutaneous disc decompression (PDD). The outcomes of using the enSpire™ for lumbar disc herniation have not been previously reported. The aim of this study was to determine the clinical effectiveness and safety of the enSpire™ interventional discectomy system for lumbar disc herniation with radiating pain. METHODS: Twelve patients with lumbar disc herniation with radiating leg pain were enrolled in the study. All patients received PDD using enSpire™. Numeric rating scale (NRS) scores for pain and Oswestry Disability Index (ODI) scores were obtained initially and after 1 and 3 months. The patients were divided into 2 groups: Group 1, in which the NRS score improved by more than 50% at 3 months after procedure, and Group 2, in which the NRS score remained the same or improved by less than 50%. RESULTS: After PDD using the enSpire™, the NRS scores decreased from 6.9 ± 1.2 to 2.8 ± 2.7; and ODI scores decreased from 25.8 ± 4.6 to 18.2 ± 5.5. No statistical differences occurred between Group 1 (n = 8) and Group 2 (n = 4) except in the duration of prior illness. CONCLUSIONS: The enSpire™ interventional discectomy system is effective and safe over the short-term, minimally invasive, and easy to use.

The Impact of Fluid Therapy Strategies on Nonoliguric Hyperkalemia in Extremely Low Birth Weight Infants

PURPOSE: The aim of this study was to characterize the changes in the incidence and clinical characteristics of nonoliguric hyperkalemia (NOHK), together with plasma potassium levels, according to the fluid therapy strategies for extremely low birth weight infants (ELBWIs) during the first few days of life. METHODS: This retrospective study enrolled ELBWIs. We analyzed the occurrence of NOHK, plasma potassium levels, other biochemical data, and fluid balances according to historically controlled strategies such as conventional limited-volume supply and low-dose calcium supplementation (P1), increased-volume supply and high-dose calcium supplementation (P2), and early aggressive nutrition (EAN) and high-dose calcium supplementation (P3). RESULTS: The incidence of NOHK and the plasma potassium levels in P2 (127 ELBWIs) were not different from those in P1 (39 ELBWIs). However, arrhythmia and fatality significantly decreased in P2 compared to those in P1. In P3 (68 ELBWIs), the incidence of NOHK after 24 h and the plasma potassium levels after 36 h of life were significantly reduced compared to those in P1 and P2. Neither arrhythmia nor fatality developed in P3. CONCLUSION: EAN combined with high-dose calcium supplementation could be a potential strategy for the prevention of NOHK along with consequent arrhythmia and fatality in ELBWIs.

Prenatal Detection of a Congenital Pancreatic Cyst by Ultrasound

We present a case of a fetal pancreatic cyst, a rare disease in fetal life, detected prenatally at 30 weeks' gestation by ultrasound. Routine ultrasound examination at 30 weeks' gestation by primary obstetrician showed a cyst on the fetal abdomen. Initially, the suspected diagnosis was a mesenteric cyst. Subsequent ultrasound examination at weeks 32, 36 showed a fetal retroperitoneal cyst. A 3.6 kg female neonate was born to 23 yr old woman by spontaneous vaginal delivery at 38 weeks' gestation. The fetus underwent exploratory laparotomy. Histopathologic and immunohistochemical diagnosis revealed the cyst to be a pancreatic cyst. Surgical outcome was excellent. Thus, we report this case of a pancreatic cyst detected via prenatal ultrasonography.

Task Analysis of Korean Geriatric Care Managers / 간호학회지

PURPOSE: This study was designed to create a job description for Korean geriatric care managers and examine performance frequency, importance, and difficulty of task elements. METHOD: The sample consisted of 38 geriatric care managers and professors who performed duties related to geriatric care management at community based-facilities in Korea. A survey method was used, and the questionnaire included frequency, importance, and difficulty of task elements in job descriptions using the DACUM method. Using SPSS WIN 10.0, descriptive statistics such as frequency distribution, means, and standard deviation were conducted to examine the subject's general characteristics, frequency, importance, and difficulties of task performance. RESULT: The job descri ption of geriatric care managers revealed 10 duties, 34 tasks, and 105 task elements. On all ten duties, the average performance frequency, importance, and difficulty was 2.55, 2.21 and 2.43 respectively. CONCLUSION: The job description of geriatric care managers includes duty, task, and task elements and the definition of a completed job. Thus we recommend a data based trial to confirm and validate the information gathered.

The clinical inflammatory reaction of Interceed(R) after laparoscopic surgery / 대한산부인과학회지

OBJECTIVE: Adhesions resulting from surgery may well be the most signigicant iatrogenic factor contributing to infertility and pelvic pain. Recently surgical barriers which mechanically separate opposing surfaces during tissue healing have been devised. Interceed(R) is an absorbable oxized regenerated cellulose barrier that adheres to the site of injury, converts into a gel, spontaneously maintains its position and dose not necessitate sutures. The goal of the study was whether the use of Interceed(R) elicits an inflammatory reaction when it remains foreign materials after laparoscopic surgery. METHODS: This randomized prospective study inculded 207 patients who had undergone laparoscopic operation at the department of Obstetric and Gynecology, Chosun University hospital, from January 2002 to December 2004. Of these 207 patients, 102 underwent laparoscopic operation with applying Interceed(R) (Group 1) and 107 underwent laparoscoic operation without applying Interceed(R) (Group 2). The WBC (White Blood Cell) count, ESR (Erythrocyte Sedimentation Rate), CRP (C-Reactive Protein), body temperature were compared postoperatively. P<0.05 was considered statistically signigicant. RESULTS: Preoperative WBC (White Blood Cell) count, ESR (Erythrocyte Sedimentation Rate), CRP (C-reactive protein), body temperature of two groups were no significant difference between Group 1 and 2. At postoperative 4th, 10th, 28th day, WBC (White Blood Cell) count, ESR (Erythrocyte Sedimentation Rate), CRP (C-reactive protein), body temperature, vaginal cuff tenderness of two groups were not significantly different between Group 1 and 2. DISCUSSION: We found that the use of Interceed(R) do not elicit an inflammatory reaction through laboratory finding and clinical finding although it remains foreign material after laparoscopic surgery. So we can use Interceed(R) for preventing adhesion safely.

Laparoscopic Burch Colposuspension with the Choi's Hook / 대한산부인과학회지

OBJECTIVE: Burch operation has been effective method for the treatment of stress incontinence. Burch operation is a well-accepted procedure for treating stress urinary incontinence secondary to urethral hypermobility without intrinsic sphincter deficiency and is the reference standard with which other procedures are compared. This study is to evaluate the effectiveness of the Choi's hook in laparoscopic Burch operation. METHODS: This study included 47 patients who had undergone laparoscopic Burch operation from October 2000 through March 2005. Of these 47 patients, 27 patients underwent traditional laparoscopic Burch operation (Group 1) and 20 patients underwent laparoscopic Burch operation with Choi's Hook on anchoring the endopelvic fascia to the Cooper's ligament (Group 2). RESULTS: The mean age of patients of Group 1 was 55.6+/-9.37 years of age and that of Group 2 was 56.0+/-5.93 years of age. There is no difference in the mean age of patients (P>0.05). The mean operating time was 90.5+/-15.32 minutes for Group 1 and 38.5+/-10.14 minute for Group 2. The mean operating time was shorter in Group 2 than Group 1 (P0.05). CONCLUSION: We performed laparoscopic Burch operation with the Choi's Hook on anchoring the endopelvic fascia to the Cooper's ligament. When we compared traditional laparoscopic Burch operation with laparoscopic Burch operation with Choi's Hook, we could shorten the operation time using the Choi's Hook.

Laparoscopic Paravaginal repair for the Treatment of Symptomatic Cystocele / 대한산부인과학회지

OBJECTIVE: Cystocele is caused by generalized relaxation or attenuation of the endopelvic fascia. The most common etiology is birth injury. The patient with cystocele usually complains stress incontinence, bearing down sensation, difficult urination, uterine prolapse. Anterior repair is the gold standard for cystocele repair, the recurrence rate is varied from 2 to 22% at a mean follow-up of 2 and 20 years. Paravaginal repair is more effective method in the patient with cystocele combined with lateral defects. The purpose of this study was to determine effects of paravaginal repair for the patients with symptomatic cystocele and paravaginal defect METHODS: We performed laparoscopic paravaginal repair to the 9 patients with cystocele (Grade II, III). Coincidental operations were Burch colposuspension (5), uterosacral ligament plication (2), anterior colporrhaphy (2), posterior colporrhaphy (9). RESULTS: Mean operation time of paravaginal repair was 58 minutes. Blood (PRC) transfused to only one patients. Postoperative outcome was excellent. There was no postoperative complication and recurrence after a follow up of 5-25 months. CONCLUSION: We think that laparoscopic paravaginal repair is highly effective method for the correction of cystocele with lateral defect.

Laparoscopic Paravaginal repair for the Treatment of Symptomatic Cystocele / 대한산부인과학회지

OBJECTIVE: Cystocele is caused by generalized relaxation or attenuation of the endopelvic fascia. The most common etiology is birth injury. The patient with cystocele usually complains stress incontinence, bearing down sensation, difficult urination, uterine prolapse. Anterior repair is the gold standard for cystocele repair, the recurrence rate is varied from 2 to 22% at a mean follow-up of 2 and 20 years. Paravaginal repair is more effective method in the patient with cystocele combined with lateral defects. The purpose of this study was to determine effects of paravaginal repair for the patients with symptomatic cystocele and paravaginal defect METHODS: We performed laparoscopic paravaginal repair to the 9 patients with cystocele (Grade II, III). Coincidental operations were Burch colposuspension (5), uterosacral ligament plication (2), anterior colporrhaphy (2), posterior colporrhaphy (9). RESULTS: Mean operation time of paravaginal repair was 58 minutes. Blood (PRC) transfused to only one patients. Postoperative outcome was excellent. There was no postoperative complication and recurrence after a follow up of 5-25 months. CONCLUSION: We think that laparoscopic paravaginal repair is highly effective method for the correction of cystocele with lateral defect.

A Case of Fetal Anesthesia with Fentanyl for Thoracentesis of Fetal Pleural Effusion / 대한산부인과학회지

Fentanyl is an opiate-like, pain-killing drug. It was found in the 1950s and prescribed from the 1960s. Fentanyl shows its effect by acting on opiate-like receptors. This case was a case of a 24-year-old primiparous woman who was referred from local clinic due to fetal pleural effusion in the left lung on antenatal ultrasonographic examination at 32 weeks of gestational age. The amount of pleural effusion increased and fetal heart deviated to the right side. We injected fentanyl 2 microgram intramuscularly into the fetal left thigh under ultrasound-guide for fetal anesthesia at 34 weeks of gestational age. After 5 minutes, we inserted 22 gage spinal needle to the left pleural cavity and aspirated 50 mL pleural fluid under ultrasound-guided. After aspiration, follow-up was performed oat one week interval and there was no more pleural fluid until delivery. At gestational age 41 weeks, the fetus was delivered vaginally as a 3.2 kg, healthy male baby. This is a case of fentanyl injection to fetus as a fetal anesthesia during thoracentesis for fetal pleural effusion at gestational age 34 weeks, we think that fentanyl is useful drug for fetal anesthesia.

Torsion of The Follopian Tube in an Adolescent Female / 대한산부인과학회잡지

Torsion of the follopian tube is an infrequent but significant cause of acute lower abdominal pain in females that is difficult to recognize preoperatively, although prompt diagnosis and timely sugical treatment are vital to salvage the oviduct. Unless a high index of suspicion is maintained for torsion of the fallopian tube in a adolescent females, this disorder may not be detected until after tubal destruction.

Bilateral Massive Ovarian Leiomyoma in an Adolescent Female / 대한산부인과학회잡지

Ovarian leiomyoma is a very uncommon tumor that usually presents as an unilateral neoplasm typically associated with uterine leiomyoma in middle aged to postmenopuasal women. These probably originate from smooth muscle cells of the ovarian blood vessel or from the smooth muscle fibers near the attachment of the ovarian ligament. We report a case of ovarian leiomyoma, bilateral and massive in 17 year-old woman. We document the smooth muscle origin of the tumors with immunohistochemical studies that show appropriate staining with antibodies to actin, desmin, vimentin, S-100 protein.

The Lived Experience of a Student Transferring into the Nursing Program / 간호학회지

PURPOSE: This study attempted to describe the essential structure of the lived experience of a students transferring into the nursing program. METHOD: The data was collected from 14 graduates and undergraduates who enrolled in nursing school as transfer students. The analysis of the data was made by phenominological analytic method suggested by Colaizzi(1978). RESULT: In this study, 6 essential themes were extracted: 'Constant anxiety of being a stranger', 'Feeling of constant burden', 'Thankfulness of a clinical practice group', 'Being supportive with each other between transferring students', 'Pleasure of studying a desired major', 'Feeling the responsibility of own choice of a new major'. CONCLUSION: With rapidly increasing number of transferring students, the significance of this study in the field of nursing is that by understanding the transferring experience of nursing students, it describes the need of systematic and emotional support for transferring students.

A Study on the Menopausal Symptoms and Quality of Life in Middle Aged Women / 간호학회지

PURPOSE: The purpose of this study is to investigate the differences Quality of Life(QOL) according to menopausal symptoms in middle aged women. METHOD: The subjects consisted of 578 women(45-60 years old) residing in urban area by convenience sampling from March 15 to May 30, 2002. The data were collected by structured questionnaire that included general characteristics, menopausal symptoms and QOL scale. the collected data were analyzed by the SPSS 11.0 program that included descriptive statistics, t-test and ANOVA. RESULT: The averaged age of menopause of subjects was 48.29 4.66 years and 74.8% in the subjects complained menopausal symptoms. As for the orders of complained menopausal symptom, it was fatigue, hot flashes, benumbed hands and feet, and irritability. The mean score of the QOL scale was showing above average level of quality of life. Religion was significantly different to the score for activity of QOL, monthly income was different to the score for activity and physical well-being of QOL. Menopausal status was significantly different to the QOL. CONCLUSION: This study suggests that a replicate study is needed. The results are also useful in developing various programs for health promotion of middle aged women.