Evidence-Based Clinical Practice Guideline for Fluid Therapy to Prevent Contrast-induced Nephropathy / 임상간호연구

PURPOSE: This study was to develop evidence-based clinical practice guideline in order to prevent contrast-induced nephropathy (CIN) for patients undergoing percutaneous coronary intervention (PCI). METHODS: The guideline was developed based on the “Scottish Intercollegiate Guidelines Network (SIGN)”. The first draft of guideline was developed through 5 stages and evaluated by 10 experts.(1) Clinical questions were ensured in PICO format.(2) Two researchers conducted a systematic search through electronic database, identifying 170 studies. We selected 27 full text articles including 16 randomized clinical trials, 7 systematic reviews, and 4 guidelines. Quality of each studies were evaluated by the Cochran's Risk of Bias, AMSTAR, K-AGREEII. Among the studies, 11 studies were excluded.(3) The strength of recommendations were classified and quality of recommendations were ranked.(4) Guideline draft was finalized.(5) Content-validation was conducted by an expert group. All contents were ranked above 0.8 in CVI. RESULTS: Evidence-based clinical practice guideline to prevent CIN was dveloped.(1) The guideline for preventing CIN recommends using 0.9% saline.(2) Standardized rate of fluid therapy is 1 to 1.5ml/kg/hr.(3) Execute hydration for 6~12hrs before PCI and after PCI. CONCLUSION: This study suggests evidence-based clinical practice guideline for preventing CIN which can be more efficiently used in clinical practice.

Inflammatory Pseudotumor of the Spleen Associated with Autoimmune Thyroiditis / 대한내과학회지

Inflammatory pseudotumor is a benign disease entity, which is histologically composed of inflammatory cells and fibrotic stroma. It is mainly found in the respiratory tract, but it has also been reported in the liver, central nervous system, soft tissues, urological system, and gastrointestinal tract. It is extremely rare in the spleen and there have been no cases of splenic inflammatory pseudotumor associated with autoimmune thyroiditis in Korea. The pathogenesis or etiology is unknown, but hypotheses include infection, autoimmunity, and parenchymal necrosis with hemorrhage. Because inflammatory pseudotumor may mimic malignant tumors on radiologic findings, pathologic confirmation is necessary to distinguish it from lymphoproliferative disorders of the spleen and other malignant tumors. We report a case of inflammatory pseudotumor of the spleen associated with autoimmune thyroiditis in a patient who complained of periumbilical pain.

Awareness and Practice of Dietary Action Guide for Adolescence among Middle and High School Students in Korea / 대한지역사회영양학회지

The purpose of the study was to examine the adolescents' awareness and practice of Dietary Action Guide for Adolescence, which was developed by the Ministry of Health & Welfare. Subjects were middle and high school students, selected one class each from all of the 16 provinces in Korea, which were 32 schools and 998 students all together. The subjects were asked to self-evaluate the degree of awareness and practice of Dietary Action Guide using the 5 point-Likert scale from July to September, 2010. On average, 55.1% of the students responded that they were aware of the Dietary Action Guide and 49.4% answered that they put Guidelines into practice. The average score of awareness and practice were 3.54 +/- 0.24 and 3.42 +/- 0.33, respectively. The awareness score was higher than those of practice score in all the questions in the 6 categories. Awareness score of female students was higher than those of male students but there was no difference by residence area. Awareness and practice of the nutrition education-experienced were higher than those of the inexperienced. Practice score was higher among middle school-students compared to high school students, which reflected the opportunity of taking nutrition related classes. This finding shows that nutrition education for adolescents is important to change their dietary behaviors regardless of gender, residence area and school level.

The Usefulness of Double Balloon Enteroscopy for Diagnosis and Treatment of Small Bowel Diseases

BACKGROUND/AIMS: Double balloon eneterscopy is a promising endoscopic method to examine the entire small bowel and to conduct therapeutic procedures. This study was performed to evaluate the clinical outcome and usefulness of double balloon enteroscopy. METHODS: We enrolled patients with suspected small bowel disease. Double balloon enteroscopy was performed in 61 patients and 89 procedures were undetaken between August 2004 and October 2007 at Hangang Sacred Heart Hospital. RESULTS: Indications for double balloon enteroscopy were obscure gastrointestinal bleeding, chronic abdominal pain or diarrhea and the presence of a suspicious small bowel tumor. Double balloon enteroscopy contributed to the diagnosis of small bowel diseases in 82.0% of patients. In 46 patients (75.4%), specific treatments were influenced by the results of double balloon enteroscopy. There were no significant complications. CONCLUSIONS: Double balloon enteroscopy is one of the most useful methods for the diagnosis and treatment of small bowel disease.

Interrelations Among Fast Food, Beverage Intake and Sociality, Anger Expression of Adolescents in the Busan Area / 대한지역사회영양학회지

The purpose of this study was to investigate the relation of the fast food and beverage intake on sociality and anger expression of adolescents. Questionnaires were distributed to the adolescents of 599 middle and high school students in Busan. According to the results, the preference-intake frequency analysis (PEA) on fast food grid, high preference and high intake frequency were 'dukbokki', 'chicken' and 'mandu' and low preference and high intake frequency were 'ramyon', 'gimbab. PEA on beverage grid, high preference and high intake frequency were 'milk dairy product', 'fruit juice', 'isotonic beverage' and low preference and high intake frequency were 'carbonate drink'. The intake frequency of 'pizza', 'sandwich', 'udong', and 'dukbokki' had a positive relationship with sociality. 'Hamburger', 'chicken', 'french fry', 'gimbab', 'mandu', and 'ramyon' showed a positive relationship with anger-out. The intake frequency of 'carbonated drink' had a negative relationship with anger-control, but 'green tea' showed a positive relation with it. 'Carbonate drink', 'isotonic beverage', 'coffee', and 'milkshake' had a negative relationship with anger-out. The explanation power (R2) of intake of fast food and beverage on sociality was 0.019~0.038, and 'carbonated drink' and 'coffee' had a negative influence on sociality. The explanation power (R2) of intake of fast food and beverage on anger expression was 0.011~0.041, and 'carbonated drink' had a negative influence on angercontrol. 'Hamburger', 'carbonated drink', and 'coffee' showed a positive influence on anger-out. From these results, it was necessary to develop the practical eating-out habits program on proper fast food and beverage choice for adolescents.

Clinical Manifestations of Mononeuritis Multiplex in Patients with Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVE: Mononeuritis multiplex is an extra-articular manifestation associated with rheumatoid arthritis. This study set out to investigate its clinical characteristics in Korea. MEHTODS: Clinical characteristics and laboratory data were compared retrospectively by review of medical records between 12 patients with mononeuritis multiplex (case) and randomly selected 116 age-matched patients without mononeuritis multiplex in patients with rheumatoid arthritis (control). RESULTS: Mean age of the case group was 51.8+/-8.4 years old with 7 males and 5 females which showed higher prevalence of male gender compared to the control group (p<0.05). There was no difference in mean duration of disease between two groups. Upper limbs, lower limbs and both upper and lower limbs were involved in 3, 7 and 2 patients, respectively. Major symptoms were tingling (66.6%), paresthesia (33.3%), pain (33.3%), foot drop (33.3%), or muscle weakness (16.7%). Skin ulceration was accompanied in 3 patients, but vasculitis of other organs was not found. Mean C-reactive protein level in the case group was 7.6+/-6.7 mg/dL, which was higher compared to 2.4+/-3.1 mg/dL in the control group (p<0.05). Rheumatoid factor was positive in 83.3% of the case, however positive rate and titer showed no significant difference with the control group. There was no difference in other extra-articular manifestations between two groups. Six patients were treated with glucocorticoid and immuno-suppressants and 6 patients with only glucocorticoid1 for 6.8+/-7.1 weeks. Symptoms improved after treatment in 10 patients but, it lasted in 2 patients. CONCLUSION: Rheumatoid arthritis associated mononeuritis multiplex was more prevalent in males with higher CRP levels, and responded well to medical intervention including glucocorticoid, and immunosuppressants.

A Case of Idiopathic Retroperitoneal Fibrosis with Acute Renal Failure / 대한신장학회잡지

Retroperitoneal fibrosis is proliferation of fibrous tissue with inflammatory process in retroperitoneal cavity. It is relatively rare disease that has been reported less than 20 cases in Korea until now. Idiopathic type is more frequent but secondary type is increasing nowadays. Secondary causes include drugs, infections, and leakage of blood or urine, malignancies, connective tissue diseases, etc. Recent studies suggest the relationship between retroperitoneal fibrosis and autoimmunity to own vascular or lipoid tissue. It can cause compression and obstruction of ureter, abdominal aorta, hypertension and finally collapse of renal function. Surgical procedure and immunosuppressive therapy consist of mainstay of management. Corticosteroid therapy may reduce inflammation and reverse fibrosis. Retroperitoneal fibrosis is thought to have some reVersible components in early stage. Corticosteroid may be used as initial therapy but more studies should be performed. We report a case of idiopathic retroperitoneal fibrosis with acute renal failure improved with ureter stent insertion and steroid therapy.

Incidence of Gallbladder Stones in Renal Transplant Recipients / 대한소화기학회지

BACKGROUND/AIMS: Gallbladder stone is one of the major cause of morbidity in adults. Renal transplantation has been found to increase the risk of gallbladder stone formation. The real incidence of gallbladder stones in renal transplant recipients is not exactly known. We performed this study to identify the risk factors for cholecystolithiasis. METHODS: We compared the prevalence of gallbladder stone in 222 renal transplantation patients with that in 222 age and sex matched controls. Patients who had chronic liver disease, renal disease, and diabetes were excluded from the control group. RESULTS: In our study, the incidence of gallbladder stones is 8.6% (19/222 patients) in renal transplantation patients, which was significantly higher than 3.60% (8/222 control) in the control group (p=0.029). In the most of our renal transplantation patients, cholecystolithiasis was asymptomatic. We did not find a difference in age, sex, duration after transplantation, causes of renal failure, resistance index between patients with and without gallbladder stones in renal transplantation patients. CONCLUSIONS: Our results suggest that the incidence of gallbladder stones is higher in renal transplant recipients than non-transplant population in Korea. Further studies will be needed to focus the factors contributing to the gallbladder stone formation after renal transplantation, especially in regard to immunosuppressive drugs.

Angiotensin Converting Enzyme Insertion/Deletion Polymorphism in Korean Patients with Rheumatoid Vasculitis / 대한류마티스학회지

OBJECTIVE: Rheumatoid arthritis has various extra-articular manifestations including rheumatoid vasculitis. Angiotensin converting enzyme (ACE) gene shows insertion/deletion polymorphism and has II, ID, DD genotypes. ACE gene is related with vasoconstriction and endothelial dysfunction in cardiovascular disease. This study was undertaken to determine the association between ACE gene polymorphism and rheumatoid vasculitis. METHODS: Twenty-nine patients were collected as rheumatoid vasculitis group. DNA was isolated from blood samples collected from 114 Korean rheumatoid arthritis patients meeting American College of rheumatology 1987 revised criteria, and 114 healthy control group. Genotyping for the angiotensin converting enzyme gene insertion/deletion polymorphism was performed by polymerase chain reaction method. RESULTS: As vasculitis manifestation, 15 patients showed neuropathy, 13 showed scleritis, 3 showed skin rash. In rheumatoid vasculitis group, II, ID and DD polymorphism was seen in 8 (27.6%), 15 (51.7%), 6 (20.7%) patients respectively and 39 (34.2%), 57 (50.0%), and 18 (15.8%) in normal controls. There was no skewing of ACE I/D polymorphism in compared with normal group. In rheumatoid arthritis control group, II, ID and DD polymorphism was seen in 37 (32.5%), 64 (56.1%), and 13 (11.4%) patients. Among rheumatoid arthritis patient, there was no significant difference between patient with vasculitis and without vasculitis. CONCLUSION: Our results showed that genetic polymorphisms of angiotensin converting enzyme insertion/deletion gene has no association with the susceptibility to rheumatoid vasculitis.

A Case of Coronary-Pulmonary Artery Fistula / 결핵

Fistula between coronary artery and pulmonary artery is a type of coronary artery anomalies. It can cause atypical chest pain and fatigue, angina pectoris, endocarditis, finally myocardial steal can result in heart failure and myocardial infarction. But only 0.1-0.2% of coronary angiographic studies reveal the communications between coronary artery and other spaces. (heart chamber, pulmonary artery etc.) It is frequently congenital, but acquired types are increasing because chest and heart manipulations such as opertion of tetralogy of Fallot, endomyocardial biopsy, radiation therapy, or penetrating blunt trauma are increasing. There are reports about repair of fistula using thrombogenic tips, coil embolization and surgical intervention. We report a connection between coronary artery and pulmonary artery in 79 years old female. She was 30 pack-years smoker and suffered from dyspnea several years with chronic obstructive pulmonary disease. She presented with atypical chest pain and palpitation after admission. Electrocardiography showed ST-T wave abnormality. Emergency coronary angiography and chest CT scan revealed coronary-pulmonary artery fistula. Transcatheter embolization was performed and she was relieved from discomforts.

A Study on Body Image Recognition, Food Habits, Food Behaviors and Nutrient Intake according to the Obesity Index of Elementary Children in Changwon / 대한지역사회영양학회지

No abstract available.

Nutrient Intake of the Rural Elderly Living in Kyungnam -Focusing on Health and Aging Status, and Life-Satisfaction / 대한지역사회영양학회지

The purpose of this study was to investigate the difference in nutrient intake according to the level of self-perception of health status, aging status and life satisfaction of the rural elderly. The factors for the study were surveyed by interview method. The subjects were 270 people(71 male, 129 female) aged over 65 years(73.5 +/- 5.6ys) in the Ham-an area. The obtained results as follows : By evaluation of self-perception of health status, 57.5% of subjects answered they are in a bad health condition. The 91.5% of subjects had diseases(rheumatitis & arthritis 31.4%, cardiovascular disease 20.2%, gastric disease 10.2%). The women had more diseases than the men(p<0.01). The subjects took medical treatment in private hospital(40.5%) and public health centers(35.0%). The men showed better level of aging status(p<0.001) and life satisfaction index(p<0.01) than the worsen. Living with spouse influenced the aging status(p<0.05) and the more pocket money influenced life satisfaction(p<0.05) and aging status(p<0.05). The elderly who eat regularly 3 times a day(p<0.05) and have a good appetite(p<0.001) appeared to have positive effect on the self perception of health status and aging status. An increasing level of the self-perception of health status and regular exercise worked to improve aging status(p<0.001). The habits of smoking and alcohol drinking, however had no effect on any index. The self-perception of health status affected the nutrient intake, but only in female elderly. The aging status and the life satisfaction index related overall positively to the intake of nutrients. In conclusion, the study shows that gender did influence nutrient intake in the elderly. The women who live alone rated lowest in social resources and health condition therefore their nutrient intake was also extremely in deficit. For successful aging, a program for rural elderly is needed, i.e. actions to provide minimum economic life, food delivery and psychological/physical health care through regional public health centers.

Analgesic Effect and Adverse Effects of Intrathecal Neostigmine Used in Spinal Anesthesia for Orthopedic Surgery / 대한마취과학회지

BACKGROUND: Intrathecal injection of analgesic agents sush as opioids, clonidine, ketamine and nalbuphine with a local anesthetic agent during spinal anesthesia for operation is an easy and convenient way to get postoperative analgesia. Intrathecal neostigmine causes an increased ACh concentration in CSF and also has an analgesic effect. This study was designed to examine its postoperative analgesic effect and adverse effects such as nausea/vomiting and urinary retention etc. METHODS: We divided 27 patients who were supposed to receive orthopedic surgery of lower extremities into 3 groups. The control group as injected with heavy bupivacaine 13 mg and normal saline and the N50 and N75 groups were injected with the same amount of bupivacaine combined with neostigmine 50 mcg and 75 mcg respectively. We examined total amount of fluid intake and side effects during operation, and time to first rescue analgesic medication, time to first urination, total applications of rescue analgesic agent, total number of urinary catheterizations for 24 hr after intrathecal injection, and adverse effects of intrathecal neostigmine in the ward. RESULTS: The N75 group showed a significantly longer analgesic duration compared with the control and N50 groups, but the incidence of urinary retention and number of urinary catheterizations increased in the N75 group significantly. Nausea/Vomiting significantly increased in N75 compared with control. Shivering was more common in N50. 2 patients who recieved neostigmine 75 mcg complained of chest discomforts suggesting myocardial ischemia in EKG taken in those episodes. CONCLUSIONS: Neostigmine 75 mcg has better analgesic effect but more frequent adverse effects than control or neostigmine 50 mcg. Therefore, we suggest using high doses of neostigmine cautiously and being aware of its side effects.

CYFRA 21-1, The New Marker for Lung Cancer / 대한임상병리학회지

BACKGROUND: Cytokeratins were subdivided into 20 different cytokeratins. It is known that cytokeratin 19 is particularly abundant in carcinoma of the lung. METHOD: A sandwich enzyme-linked immunosorbent assay called CYFRA 21-1, combining two monoclonal antibodies directed specifically aganist cytokeratin 19 was done by ES-300(Boehringer Mannheim, Germany). We investigated the diagnostic value of the new tumor marker CYFRA 21-1 in lung cancer in comparison to carcinoembryonic antigen(CEA) and neuron specific enolase(NSE) in the pilot study on 39 serum samples from lung cancer (17 squamous cell cancer, 11 adenocarcinoma, 11 small cell carcinoma) and 51 benign lung diseases and 41 normal healthy persons. RESULTS: Postulating a specificity 95% versus benign lung disease and healthy group, the diagnostic sensitivity of CYFRA 21-1 in lung cnacer independent of histologic type was 43.6% whereas CEA was 48.7% and NSE was 30.8%. The diagnostic sensitivity is increased to 69.2% by combining CYFRA 21-1 with CEA. Classifying the lung carcinomas following their histologic type, squamous cell carcinomas proved to possess the highest CYFRA 21-1 sensitivity(CYFRA 21-1 47.1%, CEA 23.5%, NSE 11.8%) and the combination with CEA 52.9% could not markedly increase the number of true-positive test results. In adenocarcinoma, CEA possessed the highest sensitivity (81.8%) whereas CYFRA 21-1 was 45.5% and NSE was 9.1%. In small cell carcinoma of lung, NSE possessed the highest sensitivity(81.8%) whereas CYFRA 21-1 was 36.4% and CEA was 54.5%. CONCLUSION: This study indicates that CYFRA 21-1 has a potential as a new marker for squamous cell lung cancer. If histologic type is unknown at the time of primary diagnosis. the combined determination of CYFRA 21-1 and CEA showed the best discrimination between benign and malignant lung disease.

Anesthetic Management of the Hypothermic Patient with Intracranial Hemorrhage / 대한마취과학회지

Hypothermia is defined as a core temperature of less than 35 degrees C. Hypothermia changes homeostasis of human body. It includes neurologic, cardiovascular, and metabolic abnormalities. we have anesthetized a woman patient who had intracranial hemorrhage with accidental hypothermia of 27.8 degrees C. We managed for elevation of body temperature with elevation of room temperature (30 degrees C), bladder irrigation with warm saline, application of warming pad and infusion of warming fluid during 4 hours and 20 minutes. At the end of anesthesia, her body temperature was 34.3 degrees C.

Comparison of Postoperative Analgesia and Side Effects of Continuous Epidural Morphine Infusion and Continuous Intravenous Morphine Infusion following Cesarean Section / 대한마취과학회지

BACKGROUND: Continuous epidural morphine infusion is a good and popular method to control postoperative pain. But intravenous morphine infusion after general anesthesia can avoid anxiety during operation and also control postoperative pain. We compared analgesia and side effects between continuous epidural infusion and continuous intravenous infusion of morphine sulfate to control of postoperative pain after cesarean section. METHODS: Forty women who received cesarean section were randomly divided into epidural and IV groups. Morphine 0.08 mg/kg was administered intravenously as an initial loading dosage for both groups. Morphine 0.08 mg/kg for epidural group or morphine 0.8 mg/kg for IV group was diluted into 96ml of normal saline. A mixture was injected into Two-day Infusor which is continuously infused 2 ml/hr. The patients received morphine solution into epidural or intravenous route with Two-day Infusor according to their allocated group. The assessments for pain score with VAS, VRS, patient's satisfaction score and side effects were made at recovery room, 0.5, 3, 12, 24, 36, 48 and 60 hours after operation. RESULTS: The VAS in IV group was significantly higher than that in epidural group at 3, 12, 24 and 36 hours after the operation (P<0.05). The VRS in IV group was significantly higher than in epidural group at recovery room and 3 hours of postoperative period (p<0.05). The frequency of pruritus, nausea, vomiting, back pain and urinary retention were less in IV group than in epidural group. The patient's satisfaction scores were similar in both groups. CONCLUSIONS: The management of postoperative pain in epidural group was more effective than the continuous intravenous morphine infusion. But the incidence of complications was more frequent in the epidural group while patient's satisfaction scores were similar in both groups. Therefore, the continuous intravenous morphine infusion can be used effectively as a postoperative pain management.

Caudal Anesthesia for Pediatric Surgery & Postoperative Pain Control / 대한마취과학회지

The caudal epidural anesthesia has been popular due to the postoperative pain relief and the reduction of the amount of general anesthetics. It is also technically simple and safe both for inpatients and outpatients under the age of 7 Year. The aim of this study was to determine the adequate dosage and degree of postoperative pain relief according to the different local anesthetics. We have performed the caudal anesthesia in 60 patients from the age of 10 month to 7 year. All caudal blocks were performed under light general anesthesia in order to relief the fear and anxiety of operation. The patients were divided by 4 groups of each 15 children. Group 1 (control group) for 1% lidocaine 1 ml/kg, Group 2 for 1% lidocaine 0.8 ml/kg, Group 3 for 0.25% bupivacaine 0.8 ml/kg, Group 4 for 0.25% bupivacaine 0.6 ml/kg. All groups were given 1:200,000 epinephrine. The overall success rate of caudal blocks was 98%. Complication was 3 cases. As the result of this study, Group 1 (control group): There was sensory block over T4 (20%). The degree of motor block was very high(73.3%). Group 2 and 3: There was no sensory block over T4. Duration of postoperative analgesia was long enough compared to the control group (p<0.05). The degree of motor block was less than the control group. Group 4: The height of most sensory block was below T8 (80%). The degree of motor block was very low (p<0.05) and duration of postoperative analgesia was short compared to the control group (p<0.001). Therefore it is considered that caudal blocks in Group 2 & 3 were adequate dosage for the pediatric operation.

A Comparative Study of Epidural Anesthesia Between Single and Mixture Injections / 대한마취과학회지

Much has been tried to avoid the toxicity and increase the quality of local anesthesia during epidural anesthesia. One idea is that a mixture of local anesthetics would give better result than separate in jections. This study was undertaken to compare the use of lidocaine alone in contrast to a lidoca-ine-tetracaine mixture. Thirty three cases of epidural anesthesia were performed at Dae-Jeon Eul Ji Hospital from Jan. to Nov. 1985. The results were as follow; 1) There was no difference in the time of onset of anesthesia between the single k Mixt-ure groups. 2) The duration of anesthesia from the mixture was longer than lidocaine by itself. 3) Muscle relaxation from the mixture was superior to lidocaine alone. 4) Toxicity of the mixture was no more than lidocaine alone. 5) In all the groups, pressure drop in diastole was more than that of systole. The heart rate was normal or slightly increased. In conclusion, the use of the lidocaine-tetracaine mixture was better than lidocaine alone for epidural anesthesia.

A Study of Changes ia Norepinephrine and Epiaephrine during Endotracheal Intubation / 대한마취과학회지

This work was done to measure the plasma concentration of catecholamines esp. norepinephrine and epineparine after eadotracheal intubation and so study the interrelation between the blood pressure and pulse rate and catecholamines. All seven patients studied were normotensive men with general anesthesia including eadotracheal intubation, systolic blood pressure, diastolic blood pressure and pulse rate were increased to 36+/-4.72 torr, 31+/-5.71 torr, and 34+/-6.23min. respectively. Norepinephrine and epinsphrine were also increased to 165+/-28.55pg/ml and 88+/-27.97pg/ml respectively. Those results show that the rise of blood pressure and pulse rate after endotracheal intubation may result from increased catecholamines.

Unilateral Tension Pneumothorax during General Anesthesia - A case report / 대한마취과학회지

A caae is preaented of unilataral tension pneumothorax in a 5 year old patieat who underwent a cleft palate. This complication is belived to have been due to ventilation of high intratracheal pressure with high fresh gas flow (8L/min). It is suggested to use a correct sise tube, ventilation of a proper intratracheal pressure with appropriate fresh gas flow and to monitor breathing sound with precordial stethosco during E.N.T. operation.