Effects of Relational Self and Negative Ideation of Teachers on Coping Type for School-aged Attention Deficit Hyperactivity Disorder / 정신간호학회지

PURPOSE: The purpose of this study was to identify predictors influencing relational self and negative thinking on coping among teachers working with students with attention deficit hyperactivity disorder (ADHD). METHODS: A cross sectional study design was conducted with 212 teachers in six elementary schools located in D and C cities. Data were analyzed using t test, one way ANOVA, Pearson's correlation coefficients, and stepwise regression analysis with SPSS 18.0. RESULTS: The significant predictive factor for the active coping type was perceived support in relational self. Empathy care was as a significant factor for the passive coping type. Relationship avoidance and agency were significant predictive factors for negative coping with ADHD students. Active and passive coping had significant negative correlations with social worry. Significant factors for positive coping were attendance at ADHD workshops and number of years of teaching. CONCLUSION: Results suggest that it is important to focus on teachers having a positive aspect in the classroom, using new strategies, and understanding their own inner factors of perceived support and empathy care in order to provide positive coping and enhance relationships with ADHD students. To further enhance positive coping and perceived support and to reduce social worry, teachers should use community resources, especially psychiatric health nurses.

The Clinical Usefulness of Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy for Rectal and Perirectal Lesions

BACKGROUND/AIMS: Endoscopic ultrasound-guided fine needle aspiration and/or biopsy (EUS-FNA/B) have been used to diagnose subepithelial tumors (SETs) and extraluminal lesions in the gastrointestinal tract. Our group previously reported the usefulness of EUS-FNA/B for rectal and perirectal lesions. This study reports our expanded experience with EUS-FNA/B for rectal and perirectal lesions in terms of diagnostic accuracy and safety. We also included our new experience with EUS-FNB using the recently introduced ProCore needle. METHODS: From April 2009 to March 2014, EUS-FNA/B for rectal and perirectal lesions was performed in 30 consecutive patients. We evaluated EUS-FNA/B performance by comparing histological diagnoses with final results. We also investigated factors affecting diagnostic accuracy. RESULTS: Among 10 patients with SETs, EUS-FNA/B specimen results revealed a gastrointestinal stromal tumor in 4 patients and malignant lymphoma in 1 patient. The diagnostic accuracy of EUS-FNA/B was 50% for SETs (5/10). Among 20 patients with non-SET lesions, 8 patients were diagnosed with malignant disease and 7 were diagnosed with benign disease based on both EUS-FNA/B and the final results. The diagnostic accuracy of EUS-FNA/B for non-SET lesions was 75% (15/20). The size of lesions was the only factor related to diagnostic accuracy (P=0.027). Two complications of mild fever and asymptomatic pneumoperitoneum occurred after EUS-FNA/B. CONCLUSIONS: The overall diagnostic accuracy of EUS-FNA/B for rectal and perirectal lesions was 67% (20/30). EUS-FNA/B is a clinically useful method for cytological and histological diagnoses of rectal and perirectal lesions.

The Clinical Usefulness of Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy for Rectal and Perirectal Lesions

BACKGROUND/AIMS: Endoscopic ultrasound-guided fine needle aspiration and/or biopsy (EUS-FNA/B) have been used to diagnose subepithelial tumors (SETs) and extraluminal lesions in the gastrointestinal tract. Our group previously reported the usefulness of EUS-FNA/B for rectal and perirectal lesions. This study reports our expanded experience with EUS-FNA/B for rectal and perirectal lesions in terms of diagnostic accuracy and safety. We also included our new experience with EUS-FNB using the recently introduced ProCore needle. METHODS: From April 2009 to March 2014, EUS-FNA/B for rectal and perirectal lesions was performed in 30 consecutive patients. We evaluated EUS-FNA/B performance by comparing histological diagnoses with final results. We also investigated factors affecting diagnostic accuracy. RESULTS: Among 10 patients with SETs, EUS-FNA/B specimen results revealed a gastrointestinal stromal tumor in 4 patients and malignant lymphoma in 1 patient. The diagnostic accuracy of EUS-FNA/B was 50% for SETs (5/10). Among 20 patients with non-SET lesions, 8 patients were diagnosed with malignant disease and 7 were diagnosed with benign disease based on both EUS-FNA/B and the final results. The diagnostic accuracy of EUS-FNA/B for non-SET lesions was 75% (15/20). The size of lesions was the only factor related to diagnostic accuracy (P=0.027). Two complications of mild fever and asymptomatic pneumoperitoneum occurred after EUS-FNA/B. CONCLUSIONS: The overall diagnostic accuracy of EUS-FNA/B for rectal and perirectal lesions was 67% (20/30). EUS-FNA/B is a clinically useful method for cytological and histological diagnoses of rectal and perirectal lesions.

Factors Affecting Intraoperative Body Temperature in Surgical Patients with Laparotomy under General Anesthesia

PURPOSE: The study was conducted to identify factors affecting the intraoperative core body temperature (CBT) of surgical patients under general anesthesia. METHODS: This study was performed through a prospective descriptive research design. The sample consisted of 138 patients who had undergone elective laparotomy surgery. Age, weight, height, the basal preoperative CBT, blood pressure, and heart rate were collected. CBT was again measured at induction of anesthesia, 1 hour, 2 hours, and 3 hours following induction of general anesthesia. RESULTS: Factors affecting intraoperative hypothermia <36degrees C at 1 hour following induction, were CBT at induction and total body fat (TBF) (R2=.569, p<.001); at 2 hours after induction, CBT at induction and TBF (R2=.507, p<.001); at 3 hours after induction, CBT at induction (beta=0.34), TBF, age and the ambient temperature in the operating room (R2=.449, p<.001). CONCLUSION: CBT at induction and TBF appear to be factors affecting intraoperative CBT within 2 hours after induction of anesthesia; CBT at induction, TBF, advanced age and the ambient temperature after 3 hours following induction. We recommend keeping surgical patients warm before induction of anesthesia and providing intraoperative warming for surgical patients of advanced age with low TBF and when the duration of general anesthesia will last more than 3 hours.

Clinical Features and Prognosis of Resectable Primary Colorectal Signet-Ring Cell Carcinoma

BACKGROUND/AIMS: We attempted to investigate the prognosis of signet-ring cell carcinoma (SRC) patients who underwent curative surgery by comparing them with age-, sex-, and stage-matched non-mucinous adenocarcinoma (NMAC) patients. METHODS: Between January 2003 and December 2011, 19 patients with primary SRC of the colorectum underwent curative surgery. Four SRC patients under the age of 40 were excluded, and the clinicopathological data of 15 patients (7 men; median age, 56 years) were reviewed and compared with the data of 75 NMAC patients matched by age, sex, and pathologic stage. RESULTS: The median follow-up duration was 30.1 months for the SRC group and 43.7 months for the NMAC group (P=0.141). Involvement of the left side of the colon (73.3% vs. 26.7%, P=0.003) and infiltrative lesions such as Borrmann types 3 and 4 (85.7% vs. 24.0%, P=0.001) were more common in the SRC group than in the NMAC group. The five-year overall survival rate was significantly lower for patients with SRC than for those with NMAC (46.0% vs. 88.7%, hazard ratio, 6.99; 95% confidence interval, 2.33-20.95, P=0.001). CONCLUSIONS: Patients with even resectable primary colorectal SRC had a poorer prognosis than age-, sex-, and stage-matched colorectal NMAC patients.

Single Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients Who Underwent a Gastrectomy with Roux-en-Y Anastomosis: Six Cases from a Single Center

Patients with altered anatomy such as a Roux-en-Y anastomosis often present with various pancreaticobiliary problems requiring therapeutic intervention. However, a conventional endoscopic approach to the papilla is very difficult owing to the long afferent limb and acute angle of a Roux-en-Y anastomosis. Balloon-assisted enteroscopy can be used for endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered anatomy. We experienced six cases of Roux-en-Y anastomosis with biliary problems, and attempted ERCP using single balloon enteroscopy (SBE). SBE insertion followed by replacement with a conventional endoscope was attempted in five of six patients. The papilla was successfully approached using SBE in all cases. However, therapeutic intervention was completed in only three cases because of poor maneuverability caused by postoperative adhesion. We conclude that in patients with Roux-en-Y anastomosis, the ampulla can be readily accessed with SBE, but longer dedicated accessories are necessary to improve this therapeutic intervention.

Evaluation of the Feasibility and Efficacy of Forward-Viewing Endoscopic Ultrasound

BACKGROUND/AIMS: We aimed to evaluate the feasibility and efficacy of a forward-viewing linear endoscopic ultrasound (FV-EUS) in diagnostic EUS procedures compared to standard oblique-viewing EUS (OV-EUS). METHODS: This study was a prospective, randomized study that permitted crossover. Fifty-one patients with subepithelial pancreatobiliary and upper gastrointestinal lesions underwent FV-EUS and OV-EUS sequentially, in random order. The EUS visualization was performed by a novice endosonographer, and the image quality of specific lesions was scored by an expert endosonographer. If fine-needle aspiration (FNA) was indicated, it was performed using both echoendoscopes by an expert endosonographer. RESULTS: Both of the EUS procedures had similar visualization times and image quality. In general, the visualization time was inversely related to the diameter of the specific lesions. In subepithelial lesions of the stomach and duodenum, the visualization time (98.8+/-62.2 seconds vs 139.0+/-66.6 seconds, p=0.008) and image quality (4.1+/-1.3 vs 3.3+/-1.7, p=0.02) of FV-EUS were significantly superior to OV-EUS. FV-EUS-guided FNA of pancreatic masses was successful in seven patients (87.5%). CONCLUSIONS: FV-EUS may increase the ease of access to gastrointestinal subepithelial lesions compared to conventional OV-EUS. The performance of FV-EUS for evaluating pancreatobiliary diseases and performing interventions was comparable to conventional OV-EUS.

A Septic Abortion Caused by Candida glabrata Chorioamnionitis Following in Vitro Fertilization and Embryo Transfer / 대한내과학회지

Candida glabrata is a yeast that commensally colonizes the upper cervix and vagina and has low pathogenicity in immunocompetent hosts. Here we report a case of C. glabrata chorioamnionitis and septic abortion following in vitro fertilization and embryo transfer (IVF-ET). This case suggests that infection in the upper vagina and cervix should be considered prior to having IVF-ET. We encountered a rare case of C. glabrata chorioamnionitis and septic abortion; therefore, we report this case with a review of the literature.

A Case of Adult-Onset Still's Disease Presenting with Periorbital Edema

Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology that is characterized by high-spiking fever, arthralgia, sore throat, and skin rash. The typical rash of AOSD is an evanescent, salmon-colored erythema, which is considered to be the major diagnostic criterion. Recently, other cutaneous manifestations of AOSD, such as persistent plaque and urticaria, have been reported. Here, we report a rare case of AOSD presenting with periorbital swelling and erythema. A 47-year-old woman was presented with periorbital swelling, erythema, high fever, arthritis, and a sore throat. One year prior to admission, she was diagnosed with AOSD based on the diagnostic criteria of Yamaguchi. The patient's periorbital swelling and erythema may not have been associated with periorbital cellulitis because they did not respond to antibiotics but did improve after treatment with steroids. Considering all of her signs and symptoms with a history of AOSD, periorbital lesion was suspected as atypical cutaneous manifestation of AOSD.

Validity and Reliability of CAT and Dyspnea-12 in Bronchiectasis and Tuberculous Destroyed Lung / 결핵및호흡기질환

BACKGROUND: The objective of this study was to assess the validity and reliability of the Korean version of chronic obstructive pulmonary disease assessment test (CAT) and Dyspnea-12 Questionnaire for patients with bronchiectasis or tuberculous destroyed lung. METHODS: For 62 bronchiectasis patients and 37 tuberculous destroyed lung patients, 3 questionnaires including St. George's Respiratory Questionnaires (SGRQ), CAT, and Dyspnea-12 were obtained, in addition to spirometric measurements. To assess the validity of CAT and Dyspnea-12, correlation with SGRQ was evaluated. To assess the reliability of CAT and Dyspnea-12, Cronbach's alpha coefficient was calculated. RESULTS: The mean ages of the patients were 60.7+/-8.3 years in bronchiectasis and 64.4+/-9.3 years in tuberculous destroyed lung. 46.8% and 54.1% were male, respectively. The SGRQ score was correlated with the score of the Korean version of CAT (r=0.72, p<0.0001) and Dyspnea-12 (r=0.67, p<0.0001) in bronchiectasis patients. The SGRQ score was correlated with the score of CAT (r=0.86, p<0.0001) and Dyspnea-12 (r=0.80, p<0.0001) in tuberculous destroyed lung patients. The Cronbach's alpha coefficient for the CAT and Dyspnea-12 were 0.84 and 0.90 in bronchiectasis, and 0.88 and 0.94 in tuberculous destroyed lung, respectively. CONCLUSION: We found that Korean version of CAT and Dyspnea-12 are valid and reliable in patients with tuberculous destroyed lung and bronchiectasis.

A Case of Neurotoxicity Induced by Valaciclovir in a Continuous Ambulatory Peritoneal Dialysis Patient / 영남의대학술지

Valaciclovir is metabolized to acyclovir after ingestion and thereafter exerts its antiviral activity. Because of its superior pharmacokinetic profile, it has quickly replaced acyclovir in the treatment of herpesvirus infection. Neurotoxicity caused by valaciclovir has been reported, however, among patients with pre-existing impaired renal function. This paper reports a case of neurotoxicity of valaciclovir in a patient with end-stage renal disease who was undergoing continuous ambulatory peritoneal dialysis (CAPD). A 67-year-old female on CAPD took 500 mg of valaciclovir twice for herpes zoster. After she took her second dose orally, she developed confusion and disorientation, along with involuntary movements. Her mental confusion progressed to a coma. Discontinuation of valaciclovir showed no rapid improvement. There- fore, hemodialysis was started. After two sessions of hemodialysis, the patient became alert; and after four sessions of hemodialysis, her neurological abnormalities were completely reversed. In conclusion, valaciclovir can induce life-threatening neurotoxicity, especially in CAPD patients, even with appropriate dose reduction, which can be effectively managed by hemodialysis.

Validation of the Korean Version of Chronic Obstructive Pulmonary Disease Assessment Test (CAT) and Dyspnea-12 Questionnaire / 결핵및호흡기질환

BACKGROUND: The object of this study was to assess the validity and reliability of the Korean versions of chronic obstructive pulmonary disease assessment test (CAT) and Dyspnea-12 Questionnaire for patients with chronic pulmonary obstructive disease (COPD). METHODS: For the 127 COPD patients, we obtained the Korean versions of the 3 questionnaires being tested: St George's Respiratory Questionnaire (SGRQ), CAT, and Dyspnea-12 with spirometric measurements. To assess the validity of CAT and Dyspnea-12, their correlation with SGRQ was evaluated. To assess the reliability of CAT and Dyspnea-12, Cronbach's alpha coefficient was evaluated. RESULTS: The mean age of patient participants was 68.6+/-7.5 years; 97.6% were male. The SGRQ score was correlated with the scores of the Korean version of CAT (r=0.71, p<0.0001) and Dyspnea-12 (r=0.73, p<0.0001). The Cronbach's alpha coefficient for the CAT and Dyspnea-12 were 0.77 and 0.78, respectively. CONCLUSION: The Korean versions of CAT and Dyspnea-12 were shown to be valid and reliable for the Korean COPD patients.

Validation of the Korean Version of Chronic Obstructive Pulmonary Disease Assessment Test (CAT) and Dyspnea-12 Questionnaire / 결핵및호흡기질환

BACKGROUND: The object of this study was to assess the validity and reliability of the Korean versions of chronic obstructive pulmonary disease assessment test (CAT) and Dyspnea-12 Questionnaire for patients with chronic pulmonary obstructive disease (COPD). METHODS: For the 127 COPD patients, we obtained the Korean versions of the 3 questionnaires being tested: St George's Respiratory Questionnaire (SGRQ), CAT, and Dyspnea-12 with spirometric measurements. To assess the validity of CAT and Dyspnea-12, their correlation with SGRQ was evaluated. To assess the reliability of CAT and Dyspnea-12, Cronbach's alpha coefficient was evaluated. RESULTS: The mean age of patient participants was 68.6+/-7.5 years; 97.6% were male. The SGRQ score was correlated with the scores of the Korean version of CAT (r=0.71, p<0.0001) and Dyspnea-12 (r=0.73, p<0.0001). The Cronbach's alpha coefficient for the CAT and Dyspnea-12 were 0.77 and 0.78, respectively. CONCLUSION: The Korean versions of CAT and Dyspnea-12 were shown to be valid and reliable for the Korean COPD patients.