Development and Evaluation of an Integrative Palliative Care Scale for Cancer Patients / 한국간호교육학회지

PURPOSE: This study was done to develop and to evaluate an integrative palliative care scale for cancer patients. METHODS: The process included construction of a conceptual framework, generation of initial items, verification of content validity, selection of secondary items, preliminary study, and extraction of final items. The participants were 173 cancer patients in Daegu and Gyeongbuk. Item analysis, factor analysis, criterion related validity, and internal consistency were used to analyze the data. RESULTS: Eighteen items were selected for the final scale, and categorized into 3 factors explaining 58.3% of total variance. The factors were labeled as social/environmental palliative care (9 items), psychological palliative care (4 items), and physical palliative care (3 items), and spiritually palliative care (2 items). The scores for the scale were significantly correlated with the quality of life of cancer patients. Cronbach's alpha coefficient for the 18 items was .88. CONCLUSION: The above findings indicate that the integrative palliative care scale has good validity and reliability when used for cancer patients.

Invasive Lobular Carcinoma: MRI Features and Clinicohistological Characteristics According to the ER, PR, and HER2 Statuses

PURPOSE: To investigate correlations of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor type 2 (HER2) statuses with magnetic resonance imaging (MRI) features and clinicohistological characteristics in patients with invasive lobular carcinoma (ILC). MATERIALS AND METHODS: Data from 64 histologically confirmed ILCs were analyzed retrospectively. Preoperative breast MRI was reviewed for morphology and dynamic contrast-enhanced kinetics of the tumor. Pathologic reports were reviewed for ER, PR, and HER2 positivity, tumor size, lymph node metastasis, and the number of metastatic lymph nodes. Furthermore, there was an investigation of the MRI features and clinicohistologic characteristics, according to the ER, PR, and HER2 statuses. RESULTS: A significant difference in MRI features and clinicohistological tumor characteristics were observed only in relation to PR status. Of the 64 ILCs, 10 (15.6%) were PR negative. PR negative cancers, compared with PR positive cancers, were more likely to present as non-mass enhancement (P = 0.027); have a significantly larger mean tumor size (5.00 +/- 1.05 cm vs. 2.57 +/- 0.21 cm, P = 0.021); and have significantly more metastatic lymph nodes (P = 0.010). CONCLUSIONS: PR negative ILC presented more frequently as non-mass enhancement on MRI, with larger tumors and increased numbers of metastatic lymph nodes. Therefore, the PR status plays an important role in determining MRI features and clinicohistological characteristics of ILC.

MR Spectroscopy and Diffusion Weighted Imaging Findings of Primary Non-Hodgkin Lymphoma of the Breast: Two Case Reports

Primary non-Hodgkin lymphoma (NHL) of the breast is a very rare disease, and the mammographic and ultrasonographic findings of breast lymphoma are variable. There are several reports of magnetic resonance (MR) imaging findings in patients with breast lymphomas; however, few reports have described the findings observed on MR spectroscopy or the features of diffusion weighted (DW) imaging. The authors report the findings of classical MR imaging, MR spectroscopy and DW imaging of a 48-year-old woman and a 40-year-old woman with primary non-Hodgkin's lymphoma of breasts. Mammography and breast ultrasonography revealed a mass with circumscribed margin. The mass showed strong enhancement after contrast injection on MR imaging. DW imaging showed reduced diffusion and high-amplitude choline (Cho) peak at 3.22 ppm was detected by single voxel MR spectroscopy which was consistent with malignancy.

Correlation between Frailty Level and Adverse Health-related Outcomes of Community-Dwelling Elderly, One Year Retrospective Study / 가정의학회지

BACKGROUND: Frailty is considered to be a clinical syndrome characterized by decreased physiological reserves associated with a greater risk of health-related problems, hospitalization, and death. The current study examined hospitalization, falls, cognitive decline and disability between robust, prefrail and frail elderly in one year. METHODS: 110 participants aged 65 or more who visited two senior welfare centers in Seoul from February 2008 to June 2008 were surveyed again from March 2009 to June 2009 with demographic characteristics, number of chronic diseases and medication, study of osteoporotic fractures (SOF) frailty index, instrumental activity of daily living (IADL), depression, mini-mental state examination-Korean version (MMSE-K), falling history and admission history within one year. These results were compared with participants' previous survey done one year ago. RESULTS: Among total 110 subjects, 48 (44%) robust, 30 (27%) prefrail, and 32 (29%) frail subjects changed to 26 (24%), 54 (49%), and 30 (27%) respectively over the year. There were statistical significances in age, number of chronic disease, depressive mood, MMSE, falls, hospitalization, IADL disability contributing to frailty (P < 0.05). Frailty defined by SOF frailty index was associated with greater risk of adverse outcomes. Frail subjects had a higher age-adjusted risk of cognitive function decline (odds ratio [OR], 3.57), disability (OR, 9.64), fall (OR, 5.42), and hospitalization (OR, 4.45; P < 0.005). CONCLUSION: The frailty index like SOF frailty index might predict risk of falls, disability, hospitalization, and cognitive decline in the elderly, emphasizing special attention to the individuals showing frailty in outpatient examination.

The Role and Difficulties of the Use of Routine Screening Abdomen Ultrasound for the Detection of a Liver Metastasis in Postoperative Breast Cancer Patients

PURPOSE: To evaluate the role and difficulties of the use of routine abdomen ultrasound (US) in postoperative breast cancer patients. MATERIALS AND METHODS: We reviewed the clinical records of 2460 patients who received breast cancer surgeries and underwent routine follow-up abdomen US for more than five years. We evaluated the number and clinical conditions of patients with a liver metastasis. We also evaluated the cut-off point of the breast cancer stage where a metastasis was likely to occur using the chi-squared test and receiver operator characteristic (ROC) analysis. RESULTS: A metastasis developed in 238 patients (9.7%), and the liver was the third most common organ site. However, just 24 (0.98%) patients presented only with a liver metastasis. Among these 24 patients, a metastasis was detected in 17 patients with the use of routine abdomen US. The cut-off point for a metastasis was Stage 3A. CONCLUSION: The use of routine screening abdomen ultrasound for the detection of a liver metastasis in postoperative breast cancer patients is not recommended. However, US can be used selectively in patients with clinical symptom or that present with a high stage equal or greater than Stage 3A.

Cystic Pulmonary Chondroid Hamartoma: A Case Report

Hamartomata is the most common benign type of tumor, occuring in the lung. However, a cystic pulmonary hamartoma is extremely rare, and is difficult to diagnose due to its nonspecific nature. We report a case of cystic pulmonary hamartoma in which a popcorn-like calcification is clearly identified, thus enabling a confident diagnosis of the disease.

The Short-Term Effects of Balloon-Occluded Retrograde Transvenous Obliteration, for Treating Gastric Variceal Bleeding, on Portal Hypertensive Changes: a CT Evaluation

OBJECTIVE: We wanted to evaluate the short-term effects of balloon-occluded retrograde transvenous obliteration (BRTO) for treating gastric variceal bleeding, in terms of the portal hypertensive changes, by comparing CT scans. MATERIALS AND METHODS: We enrolled 27 patients who underwent BRTO for gastric variceal bleeding and they had CT scans performed just before and after BRTO. The pre- and post-procedural CT scans were retrospectively compared by two radiologists working in consensus to evaluate the short-term effects of BRTO on the subsequent portal hypertensive changes, including ascites, splenomegaly, portosystemic collaterals (other than gastrorenal shunt), the gall bladder (GB) edema and the intestinal wall edema. Statistical differences were analyzed using the Wilcoxon signed rank test and the paired t-test. RESULTS: Following BRTO, ascites developed or was aggravated in 22 (82%) of 27 patients and it was improved in two patients; the median spleen volumes increased from 438.2 cm3 to 580.8 cm3, and based on a 15% volume change cut-off value, splenic enlargement occurred in 15 (56%) of the 27 patients. The development of new collaterals or worsening of existing collaterals was not observed in any patient. GB wall edema developed or was aggravated in four of 23 patients and this disappeared or improved in five; intestinal wall edema developed or was aggravated in nine of 27 patients, and this disappeared or improved in five. Statistically, we found significant differences for ascites and the splenic volumes before and after BRTO (p = 0.001 and p < 0.001, respectively) CONCLUSION: Some portal hypertensive changes, including ascites and splenomegaly, can be aggravated shortly after BRTO.

A Study of Case-Based Adult Advanced Cardiac Life Support(ACLS) course in Korea

BACKGROUND: To describe the fast experience of case-leased advanced cardiac life support(ACLC) course in Korea. METHODS: We have given case-based ACLC course to 13 nurses(6 emergency nurses, 4 coronary care unit muses, 3 professors) and 17 physicians(4 emergency physicians, 12 emergency residents, 1 intem). We performed the case-based ACLS course according to 1992 American Heart Association guidelines and recommendations for advanced cardiac life support by american ACLS instructors(1 pulmonologist, 4 critical care nurses). We performed final theoretical written test and 2 times written survey (immediate and 100th day after the course) about the course. RESULTS: On final written test, all practitioners answered at leasts 70% of the questions correctly. There was no significant difference between nurses and physicians(86.2+/-3.6 of physicians and 82.5+/-6.8 of nurses, p=0.06). 90%of participants considered that case-based advanced cardiac life support was acceptable. 100th day after the course, 93%of participants answered that ACLS course have been helpful on his/her job and also want retraining of ACLS course. 70%of participants considered that ideal ACLS training committee in Korea is the Korean Society of Emergency Medicine. CONCLUSION: Case-based ACLS course is a useful educational method far physicians and nurses in Korea. In the future, we should organize Korean resuscitation committee and then make guidelines for ACLS, and then continuously educate physicians and nurses.

The Comparison of Analgesic and Hemodynamic effects in Different Nitrous Oxide Concentration

BACKGROUND: Nitrous oxide is a safe analgesics which has analgesic and sedative effects without loss of consciousness. The advantage of Nitrous oxide is that it has a rapid onset time and that we can modulate duration of its action. The purpose of this experiment is to obtain the safe and effective concentration of Nitrous oxide in Emergency Department as use of analgesics and sedative drugs. METHODS: Twenty volunteers were investigated according to double blind method. Nitrous oxide was administrated to volunteer subjects at different concentrations ; 33%, 50%, 67% each. Then we evaluated the Pain score, Blood pressure, Heart rate, Respiratory rate, Oxygen saturation and its side effects. RESULTS: Pain Score were 8.4+/-2.1 at 33%, 6.1+/-1.5 at 50%, and 3.65+/-2.2 at 67% of Nitrous oxide. Pain Score is decreased significantly following administration of Nitrous oxide at concentration of 50%, 67%(P<0.05). There was no difference between preadministration group and postadministration group. While no remarkable change in systolic blood pressure, heart rate, and oxygen saturation. Respiratory rate showed significant increase when 679o of Nitrous oxide was administrated. There was no side effect in administration of 33% of Nitrous oxide. When 50% of Nitrous oxide was administrated, there were dizziness 5(25%), paresthesia 2(10%), nausea 1(5%), palpitation 1(5%) and hyperethesia 1(5%). At 679o of Nitrous oxide, there were nausea 7(35%), dizziness 6(30%), paresthesia 5(25%), headache 5(25%), diplopia 2(10%), dysphoria 2(10%), salivation 1(5%), dyspnea 1(5%), nystagmus 1(5%), tinnitus 1(5%) and euphoria1 (5%). Incidence of side effect increased as the concentration of Nitrous oxide was increased. CONCLUSION: We can conclude that safe and effective concentration of Nitrous oxide is 50% as analgesics and sedative drugs in the emergency department.

Recovery of Acute Renal Failure Secondaruy to Ethylene Glycol Intoxicity

Ethylene glycol is a sweet-tasting liquid with industrial use as a solvent or as a starting reagent in chemical processes. Physicians are familiar with ethylene glycol because it is the major component of many antifreeze solutions and is taken in suicide attempts or, more often inadvertency. its metabolites may cause severe intoxication. Unfortunately, its metabolites are highly toxic and require rapid treatment Treatment involves correction of metabolic acidosis, ethanol administration and enhancement of elimination. The most commonly used elimination technique is hemodialysis We describe an 21-year-old man with acute renal failure due to ingestion of antifreeze that contained ethylene glycol. He was transferred to our hospital because of aggressive management The recovery of our patient with severe ethylene glycol intoxication illustrates that aggressive and early treatment can prevent mortality and morbidity.