A Case of Posterior Reversible Encephalopathy Syndrome in a Girl with Nephrotic Syndrome / 고신대학교의과대학학술지

A 12-year-old girl with nephrotic syndrome was admitted to Kosin University Gospel Hospital because of progressive generalized edema and weight gain for the last one month. From the eighth day of admission, she developed headache and generalized tonic seizures. Magnetic resonance imaging (MRI) of the brain showed multiple T2-high signal intensity lesions in the bilateral posterior parieto-occipital cortex and subcortical white matter. The convulsions responded to anticonvulsant and antihypertensive drugs but recurred again until she developed massive diuresis and became normotensive. Follow-up brain MRI 5 days later showed complete resolution of the previous abnormal lesions. The cause of Posterior Reversible Encephalopathy Syndrome (PRES) in our case remains unclear. Blood pressure has been only moderately elevated when the patient became symptomatic. Here, we report a case of minimal change nephrotic syndrome complicated by PRES with a literature review.

Effect of Postpartum Breast-feeding Support by Nurse on the Breast-feeding Prevalence / 간호학회지

PURPOSE: The purpose of this study was to investigate the effects of the professional nurse's postpartum breast-feeding support on breast-feeding prevalence for mothers who delivered in Baby-Friendly Hospitals (BFH). METHODS: This quasi experimental study was designed with a nonequivalent control group post test. The subjects of this study were 55 mothers who were hospitalized in the delivery room of a university hospital which was selected as a BFH in Daegu from October 1, 2005 to June 30, 2006. Twenty nine mothers were assigned to the experimental group and 26 mothers to the control group. Postpartum breast-feeding support by nurses' telephone calls to the experimental group was provided once a week for 4 weeks postpartum and then once a month for 16 weeks postpartum. Four post tests were given at postpartum week 4, 8, 12, and 16. The control group was given a telephone call at postpartum week 4, 8, 12, and 16. RESULTS: The breastfeeding prevalence of the experimental group was significantly higher than that of the control group for each period. CONCLUSION: Postpartum breast-feeding support by nurses may be a useful intervention to increase breast-feeding prevalence.

Clinical Significance of Mesenteric Lymph Nodes Detected on Postoperative CT after a Total Pharyngolaryngectomy and Reconstruction with a Jejunal Free Flap

PURPOSE: To investigate the clinical significance of mesenteric lymph nodes (MLNs) detected on postoperative CT images after a total pharyngolaryngectomy and reconstruction using a jejunal free flap (TPL-JFF) in patients with advanced carcinoma of the laryngo-hypopharynx. MATERIALS AND METHODS: We recruited 17 patients with available postoperative CT images following a TPL-JFF. The postoperative CT findings of the MLNs for the JFF were evaluated, including the number of MLNs, maximum-axial-diameter, shape, and presence of central necrosis or cortical enhancement, which were compared between the two groups and divided according to the presence or absence of local recurrence. RESULTS: In 16 of 17 patients except for one patient without MSN, an initial postoperative CT image demonstrated the presence of MLNs (mean number, 2; range 1-4) which had a maximal diameter of 18 mm. New or an increased number of MLNs detected on a subsequent follow-up CT examination was found in only two patients with recurrence. However, MLNs in nine patients without recurrence remained unchanged or decreased. Cortical enhancement was found more frequently in all five MLNs of the two patients with recurrence as compared to cortical enhancement in the MLNs (four among 12 MLNs: 33%) of patients without recurrence. The other findings remained the same. CONCLUSION: MLNs on postoperative CT images are very common in patients after a TPL-JFF. Although most MLNs are reactive, a new or increased number of MLNs on a subsequent follow-up CT examination should suggest the presence of a local recurrence.

Experience on Emotional Support of Hospital Nurses / 성인간호학회지

PURPOSE: This study was designed to explore what experiences nurses had while caring and providing emotional support for patients. METHODS: Participants were eight nurses working at hospitals for more than one year. Data were collected from June, 2006 to January, 2007 through in-depth interview by using tape-recordings. Data were analysed with the phenomenological method proposed by Colazzi(1978). RESULTS: From significant statements, 4 clustered themes, 7 themes and 23 sub-themes were extracted from the essential meaning of the emotional experience of hospital nurses. The 4 clustered themes were 'movement of mind', 'affection and service for patients', 'worthwhile and conflict' and 'control oneself'. The 7 themes were 'special feeling', 'rapport formation', 'consideration', 'human interaction', 'value discovery', 'loss of volition', and 'keep to balance'. CONCLUSION: Although nurses had tough experiences for providing care for patients' emotional support, they had also experienced spiritual maturity from its experience. The result of this study would contribute for nurses not only to care for patients who need emotional support but also to develop knowledge in nursing.

Perceptions of Sexuality in Unmarried Mothers / 기본간호학회지

PURPOSE: A phenomenology study was conducted to provide in-depth data to help in the understanding of young women who have become unmarried mothers. METHOD: In-depth interviews were done with 11 unmarried mothers from August 2002 to September 2003. Data were recorded and analyzed by Colaizzi method. RESULT: Significant statements consisted of 5 categories with 12 theme clusters accompanying each category. The categories were: "Sex as a tool" which included living and connections, "Sex as an expression of her desire" which included wanting and expression of love, "Sex to be dominated" which included significance, domination and negative aspects of sex, "Moral sex" which included secrecy, responsibility and connections with life, "Sex as a sense of identity" which included expression of gender and association with peer group. CONCLUSION: The results of this study will help indicate directions for care of unmarried mother, which should be based on a deep understanding of their personal perception of sexuality. Also, it can be utilized as basic materials for development of sex educational programs to prevent repeat pregnancies in unmarried women and information on consultion with unmarried mothers.

Covered Self-Expandable Metallic Stent Placement for a Post-operative Malignant Anastomotic Stricture Secondary to Recurrent Gastric Cancer

PURPOSE: To evaluate the technical feasibility and clinical effectiveness of stent placement for the treatment of a post-operative malignant anastomotic stricture secondary to recurrent gastric cancer. MATERIALS AND METHODS: Under fluoroscopic guidance, one or two covered stents were placed in 20 consecutive patients (age range, 44-75 years) with an anastomotic stricture due to a recurrent gastric malignancy. Before stent placement, all patients had severe nausea and recurrent vomiting after ingestion. RESULTS: Stent placement was technically successful for all patients, and no procedural complications occurred. After stent placement, 18 of 20 (90.0%) patients were able to ingest at least a liquid diet and had a markedly decreased incidence of vomiting. During the follow-up of 2-116 weeks (mean, 25.5 weeks), stent migration occurred in two patients (10.0%) on one day after the procedure. All patients with stent migration were treated successfully by means of placing a second stent. Three patients showed a recurrence of the stricture due to tumor overgrowth; two of the patients were treated with coaxial placement of a second stent. Another patient refused additional management. CONCLUSION: Covered self-expandable metallic stent placement seems to be technically feasible and effective for palliative treatment of a post-operative malignant anastomotic stricture secondary to recurrent gastric cancer.

Malignant Nodular Hidradenoma: A Case Report

Malignant nodular hidradenoma is a rare skin appendageal tumor, and its imaging findings have not been previously described. We experienced the case of a large malignant nodular hidradenoma of the left upper arm in a 71-year-old woman. MRI revealed a large, lobular, poorly circumscribed, soft tissue mass at the left upper arm, and the mass showed homogeneous enhancement. 18F-FDG PET/CT showed hypermetabolic activity in the left upper arm mass with a maximal standard uptake value of 19.

Transrectal Drainage of Deep Pelvic Abscesses Using a Combined Transrectal Sonographic and Fluoroscopic Guidance

PURPOSE: To evaluate the feasibility and clinical efficacy of transrectal drainage of a deep pelvic abscess using combined transrectal sonographic and fluoroscopic guidance. MATERIALS AND METHODS: From March 1995 and August 2004, 17 patients (9 men; 8 women; mean age, 39years) suffering from pelvic pain, fever and leukocytosis were enrolled in this retrospective study. Ultrasound (US) or computed tomography (CT), which was obtained prior to the procedure, showed pelvic fluid collections that were deemed unapproachable by the percutaneous transabdominal routes. Transrectal drainage of the pelvic abscess was performed under combined transrectal sonographic and fluoroscopic guidance. The causes of the deep pelvic abscess were postoperative complications (n=7), complications associated with radiation (n=3) and chemotherapy (n=1) as well as unknown causes (n=6). A 7.5-MHz end-firing transrectal US probe with a needle biopsy guide attachment was advanced into the rectum. Once the abscess was identified, a needle was advanced via the biopsy guide and the abscess was punctured. Under US guidance, either a 0.018"or 0.035" guidewire was passed through the needle in the abscess. Under fluoroscopic guidance, the tract was dilated to the appropriate diameter with sequential fascial dilators, and a catheter was placed over the guide wire within the abscess. Clinical success of drainage was determined by a combination closure of the cavity on the follow up images and diminished leukocytosis. The technical and clinical success rate, complications, and patient's discomfort were analyzed. RESULTS: Drainage was technically successful in all patients and there were no serious complications. Surgery was eventually performed in two cases due to fistular formation with the rectum and leakage of the anastomosis site. The procedure was well tolerated in all but one patient who complained of discomfort while the catheter was inserted. The catheter did not interfere with defecation and there was no incidence of catheter expulsion by defecation. CONCLUSION: Transrectal drainage of deep pelvic abscesses using ultrasound and fluoroscopic guidance is a safe, feasible procedure that is well tolerated by patients and is relatively easy to perform.

Radiologic Findings of Extraosseous Ewing's Sarcoma

PURPOSE: The purpose of this study is to evaluate the radiologic findings of the extraosseous Ewing's sarcoma. MATERIALS AND METHODS: Six patients with pathologically confirmed extraosseous Ewing's sarcoma were retrospectively reviewed. Patients included two men and four women with an average age of 21.5 years (age range 9-48 years). Plain radiographs (six patients), magnetic resonance (MR) images (five patients), computed tomographic (CT) scans (three patients) and whole body scintigraphy (two patients) were reviewed and analyzed. Images were evaluated with regard to lesion location, size, margin, muscle or bone involvement and intrinsic imaging characteristics on CT and MRI. RESULTS:The tumors were located in the thigh (three patients), back (two patients) and upper arm (one patient). The tumors ranged in size from 2.3 cm to 7.5 cm (mean, 5.2 cm), were mainly well circumscribed and showed no evidence of calcification prior to treatment. Margins were well defined in four out of the six patients. Four patients had subcutaneous lesions and the other two patients had intramuscular lesions. Muscle (two patients) and bone invasion (one patient) were present. The masses were heterogenous low signal intensity on T1 weighted images and heterogeneous high signal intensity on T2 weighted images compared with muscle. Heterogeneous enhancement within the lesion was observed in all patients on CT and MRI. Whole body scintigraphy using Tc-99 m MIBI showed increased uptake in the masses of two patients. CONCLUSION: Extraosseous Ewing's sarcomas were frequently seen as a well-circumscribed ovoid mass with nonspecific findings on CT and MRI. Despite being a relative rare tumor, it should be included in the differential diagnosis of a non-calcified soft-tissue mass, especially in subcutaneous tissue.