Risk Factors Related to Development of Delirium in Hospice Patients / 한국호스피스완화의료학회지

PURPOSE: Delirium is a common and serious neuropsychiatric complication among terminally ill cancer patients. We investigated risk factors related to the development of delirium among hospice care patients. METHODS: Between May 2011 and September 2012, we included patients who were mentally alert and had no psychiatric disease or drug addiction at the hospice ward of two local hospitals. Among them, participants who had been diagnosed with delirium by two doctors according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-4th edition) criteria were grouped as Delirium Group. We analyzed results of psychometric and other laboratory tests performed at the time of patient's admission - psychometric tests included cognitive function (mini-mental status examination, MMSE), depression (Beck Depression Inventory, BDI), anxiety, and insomnia (Insomnia Severity Index, ISI). Logistic regression analysis was used to compare delirium and the related factors. Cox's proportional hazard model was performed using significant factors of logistic regression analysis. RESULTS: Of the 96 patients who met the inclusion criteria, 41 (42.7%) developed delirium. According to the logistic regression analysis, primary cancer site, cognitive impairment (MMSE or =16), and insomnia (ISI> or =15) were significant factors related to delirium. Among the four factors, depression (OR 5.130; 95% CI, 2.009~13.097) and cognitive impairment (OR 5.130; 95% CI, 2.009~13.097) were found significant using Cox's proportional hazard model. CONCLUSION: The development of delirium was significantly related to depression and cognitive impairment among patients receiving hospice care. It is necessary to carefully monitor depression and cognitive function in hospice care.

The Association between Pain and Depression, Anxiety, and Cognitive Function among Advanced Cancer Patients in the Hospice Ward / 가정의학회지

BACKGROUND: Pain is the most common but severe physical symptom among cancer patients. This study aimed to identify correlation between pain and psychological symptoms for terminal cancer patients. METHODS: The total sample consisted of 69 subjects who were recruited through two hospice wards, limited to patients who were mentally alert and had no psychiatric diseases. The subjects were divided into two groups according to the numerical rating scale: the pain-free group, 0 to 3 points; and the pain group, 4 to 10 points. We used the Beck depression inventory (BDI), Beck anxiety inventory (BAI), mini-mental status examination-Korea (MMSE-K), and short form 36 health survey (SF-36). Logistic regression analysis was performed to verify the correlation between pain and other psychosocial disorders. RESULTS: The mean scores of BDI in the pain-free and pain groups were 25.7 and 31.5; mean BAI scores were 23.4 and 34.7; mean MMSE-K scores were 25.7 and 21.8, respectively. There were no significant differences between the two groups in SF-36 score except scores of body pain. The results of logistic regression analysis adjusted for age, sex, marital status, types of cancer, history of chemotherapy, or radiotherapy showed significant correlation between pain and depression (BDI > or = 24; odds ratio [OR], 4.199; 95% confidence interval [CI], 1.171 to 15.060), and pain and cognitive impairment (MMSE or = 22; OR, 3.011; 95% CI, 0.907 to 9.997). CONCLUSION: Pain significantly affects depression and cognitive impairment among advanced cancer patients in the hospice ward. Accordingly, more aggressive treatment of pain is required to reduce not only physical suffering but also physiological distress.

The Unusual Origin of the Sternocleidomastoid Artery from the Lingual Artery

The sternocleidomastoid (SCM) artery supplying blood to the SCM muscle has different origins according to its anatomical segment. The authors performed cadaveric neck dissection to review the surgical anatomy of neurovascular structures surrounding the carotid artery in the neck. During the dissection, an unusual finding was cited in which the SCM artery supplying the middle part of the SCM muscle originated from the lingual artery (LA); it was also noted that it crossed over the hypoglossal nerve (HN). There have been extremely rare reports citing the SCM artery originated from the LA. Though the elevation of the HN over the internal carotid artery was relatively high, the vascular loop crossing over the HN was very close to the carotid bifurcation. Special anatomical consideration is required to avoid the injury of the HN during carotid artery surgery.

Pure Epidural Cavernous Hemangioma of the Cervical Spine that Presented with an Acute Sensory Deficit Caused by Hemorrhage

Pure epidural cavernous hemangioma of the spine without vertebral involvement is rare. Due to the slow growth of this lesion, the most common symptoms are chronic pain, myelopathy, and radiculopathy. In our case, the patient complained of an acute onset sensory deficit of the C4 dermatome. An MRI revealed an epidural mass with an acute hematoma. Here, we report a case of a pure epidural cavernous hemangioma that presented with acute neurologic symptoms caused by intralesional hemorrhage and an acute epidural hematoma, which were demonstrated on the patient's MRI.

Pure Epidural Cavernous Hemangioma of the Cervical Spine that Presented with an Acute Sensory Deficit Caused by Hemorrhage

Pure epidural cavernous hemangioma of the spine without vertebral involvement is rare. Due to the slow growth of this lesion, the most common symptoms are chronic pain, myelopathy, and radiculopathy. In our case, the patient complained of an acute onset sensory deficit of the C4 dermatome. An MRI revealed an epidural mass with an acute hematoma. Here, we report a case of a pure epidural cavernous hemangioma that presented with acute neurologic symptoms caused by intralesional hemorrhage and an acute epidural hematoma, which were demonstrated on the patient's MRI.

Radiological Evaluation of Percutaneous Endoscopic Lumbar Discectomy: A Three-Year Follow-Up Study

PURPOSE: We wanted to analyze the radiological changes of the patients who underwent percutaneous endoscopic lumbar discectomy (PELD) for treating soft disc herniation. MATERIALS AND METHODS: We retrospectively reviewed 30 patients (32 cases) who were observed for a minimum of 3 years after they underwent PELD. The authors investigated the postoperative radiological changes after PELD and the related clinical outcomes. All the patients received plain X-rays, CT and MRI both preoperatively and at the final follow-up. The radiological parameters were evaluated, including the disc height, the disc signal intensity, the subchondral marrow signal intensity, the sagittal plane instability and the facet joint osteoarthritis. RESULTS: The average amount of removed disc was 1.363 g and a significant correlation was detected between the narrowing of disc height and the amount of removed disc. Although the disc height and the disc height ratio were significantly decreased (-0.97 mm and 86.9%, respectively), the angle of sagittal rotation was well maintained. There were 18 (56.3%) cases of disc signal changes, six cases (18.8%) of subchondral marrow signal changes, and three cases (9.4%) of facet joint osteoarthritis. The success rate was 90.6%. CONCLUSION: Although disc height narrowing was observed, there was no postoperative instability and the overall clinical outcome was satisfactory. Our results show that PELD is a useful and minimal invasive procedure for the selected patients who are suffering with lumbar disc herniation.

Posterior Epidural Migration of Lumbar Ruptured Disc: Report of Two Cases

Disc fragment migration occurs in 35%-72% of lumbar disc herniations. Most of the herniated disc fragments migrate in the rostal, caudal and lateral directions. Posterior epidural disc fragment migration is a rare finding and posterior migration causing Cauda Equina syndrome is exceptionally rare. We report here on two cases of L4-5 disc fragment posterior epidural migration that caused Cauda Equina syndrome, and this was diagnosed by performing radiological examination, and we also include a review of the related literature.

Symptomatic Spinal Epidural Gas-Containing Cystic Lesions: Reports of 2 Cases

Symptomatic spinal epidural gas-containing cystic lesion is a rare clinical disease entity. We recently experienced two cases of symptomatic epidural gas-containing cysts that were the main cause of the patients?radiculopathy and the cysts were removed surgically. These lesions were actually gas containing ruptured disc herniations from the vacuum discs at the same level. We report herein on the radiological findings along with conducting a review of the related literature.

Intradural Lumbar Disc Herniation with Intradural Gas: Report of Three Cases

This paper reports on three cases of an intradural lumbar disc herniation (IDLDH) that were diagnosed by a radiological examination. In all cases, an intradural vacuum (IDV) was detected on the CT scans, and the IDLDH showed iso- or lower signal intensity on the T2-weighted images. Enhanced MRI of one case revealed a small amount of air, but this was without enhancement. All the cases showed definite IDV on the CT scans, and this was an important clue for diagnosing IDLDH.

Spontaneous Epidural Hematoma at the Lumbar Facet Joint: A Case Report

Spontaneous epidural hematomas (SEHs) of the lumbar spine are rare. The pathogenesis is not entirely clear, but several reports have suggested that bleeding originating in the venous epidural plexus is the cause. This is the second report of a SEH thought to be the result of facet joint hemorrhage with no previous synovial cyst formation. A magnetic resonance image revealed a mass beginning in the left epidural space and continuing through to the left L5-S1 facet joint. Surgically, the epidural hematoma, which was covered by a very thin translucent membrane, was visualized directly. A histopathological examination revealed the wall of the epidural hematoma to be composed of very thin fibrous connective tissue with no synovium lining. The purpose of this study was to report a case of an epidural hematoma originated from lumbar facet joint, diagnosed by radiological examination, and to present a review of the subject literature.

Intradural Cervical Disc Herniation: A Case Report

Intradural cervical disc herniation is an extremely rare condition and its pathogenesis is not certain. We experienced a case of intradural cervical disc herniation at the C4-5 level in a 56-year-old man. The preoperative sagittal T1- and T2- weighted images revealed an intradural iso-intensity lesion, with the spinal cord behind the posterior longitudinal ligament at the C4-5 disc level. The post-contrast T1-weighted image revealed a peripheral enhanced intradural lesion. We report here on a case of an intradural cervical disc herniation that was diagnosed by radiological examination, and we include a review of the related literature.

Non-dysraphic Intramedullary Spinal Cord Lipoma: Case Report

Spinal cord lipomas are rare tumors with a reported incidence of 1% of all intraspinal tumors. We recently experienced a case of intramedullary lipoma without spinal dysraphism in a 58-year-old woman. MRI, CT, myelography and CT myelography showed the characteristic findings of a lipoma.

Ossified Thoracic Spinal Meningioma: Report of Two Cases

Spinal meningioma is one of relatively common spinal tumors with an incidence of 25-46%. However, ossified spinal meningioma is known to be extremely rare and its incidence of all the meningiomas is about 0.7-5.5%. Until now, there has been no report of ossified meningioma in Korea. We experienced two cases of this rare lesion, and we report on the CT and MRI findings along with a review of the related literature.

A Study of Tool Development for Powerlessness of Elderly and the Degree of Elderly's Powerlessness / 간호학회지

The purpose of this study was to develop a tool to assess the powerlessness and to measure the powerlessness of elderly. From the result of pre-test, twenty seven items were finally selected to survey the elderly's powerlessness. The questionnaires on the elderly's powerlessness were drafted so that such tool may be evaluated in accordance with the four point Likert Scale. The number of subjects is 1,150 with ages of 60 years or more and who live in a large city, a small and middle-sized city and a rural area. The subjects of the test and retest were 85 elderlies. Collected data were analyzed by utilizing SAS program with Cronbach's alpa and Pearson's correlation, factor analysis method and known group techniques, descriptive statics, t-test and ANOVA. The results from this study were summarized below: 1. When the factor analysis method was applied for validity, the tool for powerlessness of elderly was separated into 5 factors: loss of self-confidence to deal with physical, emotional, social aspects of life; expulsion by others from meaningful human relate; perception that life is meaningless and time passes quickly; falling behind young people; being rejected by other people, having no influence on others. An application of the known group technique showed a significant difference with the result of the degree of elderly's powerlessness tools developed by the two groups, with illness and without. 2. In testing reliability, it was found that coefficient of test-retest was .9435(P<.0001) when the test-retest method was used as a test of stability, and that the alpha coefficient of internal consistency was .9141 over all items within the tool of elderly's powerlessness. 3. In powerlessness of elderly, total mean is 2.8493. And in factor of powerlessness, the highest factor is falling behind young people (M=3.1713), the lowest factor is loss of self- confidence to deal with physical, emotional, social aspects of life(M=2.6080). 4. The results from the test for the degree of powerlessness, according to the subject's demographic variables, showed that there were significant differences between age, sex, marital status, educational level, religion, possession of house, job, monthly pocket money, health status, illness and a place of residence.

A study on the Noise Level and Patients' Perception of the Noise in Emergency Department / 기본간호학회지

The purpose of this study was to provide a bases for comfort of patient through of measuring the noise level on emergency room and grasping the perception to noise of inpatient. Data on noise level through sound level meter in ER and patients' perception of the noise through a structured questionnaire and were collected from August 21 to September 5 in 1998. And collected data were analyzed with SAS statistics program, descriptive statistic, t-test and ANOVA. The result of examination is as follows : 1. Among a noise level of measured highest was 64.6dB(A) in 'rounding of medical teams', the lowest was 54.8dB(A) in 'traffic noise from outside'. 2. The mean score of noise perception was 0.93. Among a kind of noise reported by the subjects that which ranked highest was 'conversation of patients' caregiver and visitors'(1.75). The ranked lowest was 'noise of air-conditioner'(0.59). 3. The relationship between perception of noise and subjects' characteristics was not significant. Therefore, based on this result, ways require to decrease the noise level in emergency department.

Abdominal Ultrasonographic Findings of Yersiniosis in Children

PURPOSE: To review abdominal ultrasonography in Yersinia Pseudotuberculosis(YP) infection. MATERIALS AND METHODS: From June 1993 through June 1994, abdominal ultrasonograms were reviewed in 36 patients with YP infection. The age of patients was from 4 to 14 years. A diagnosis of YP infection was made on the basis ofisolation of YP from stool (n=15/36, 41.7%) and by documenting at least a minimum agglutination antibody titer of1:160 or greater (n=34/36, 94.4%). RESULTS: Abdominal US findings were identifed in 33/36 (91.7%) of patients with YP infection. US abnormalities included right lower quadrant abdominal lymphadenopathy in 28/36 (77.8%) of cases ;increased bilateral renal cortical echogenecity with renal enlargement, 11/36 (30/6%) of cases ;hepatosplenomegaly, 6/36 (16.7%) of cases ; bowel wall thickening in termnal ileum and cecum, 4/36 (11/1%) of cases ; and ascites, 2/36 (5.5%) of cases. Three patients revealed no abdominal sonographic finding. CONCLUSION: We conclude that abdominal US can help in the diagnosis of YP infection when US demonstrates multiple right lower quadrant abdominal lymphadenopathy, increased renal cortical echogenecity with renal enlargement, hepatosplenomegaly, intestinal wall thickening or ascites.

Tracheal Luminal Diameter on Chest Radiographs: Demographic Data in 690 Normals

PURPOSE: To assess the normal range of transverse and AP diameter of the trachea on simple chest radiographs and to determine whether or not there is any correlation between tracheal diameter and age, sex, height, or bodyweight. MATERIALS AND METHODS: Six hundred and ninety patients with no lesion on chest radiographs and noclinical evidence of respiratory disease were involved in this study. To obtein transverse and lateral diameters,the internal diameter of the tracheal air column was measured at a level 2 cm above the top of the aortic arch onboth posteroanterior and lateral radiographs. RESULTS: The normal ranges of AP and transverse diameters of thetrachea were 16 to 25mm, and 14 to 22mm in men, respectively and 12 to 20mm and 12 to 18mm in women. Statistically significant differences were observed between AP and transverse diameter in both in men and women, the former being consistently larger than the latter in both sexes. In men, significant correlations were observed between transverse diameter and patients' height, and between AP diameter and age as well as height. In women, significant differences were observed between AP diameter and patients' height, and transverse diameter and height as well asbody weight of patients. CONCLUSIONS: Normal tracheal diameter was larger in men than in women. and AP diameter was larger than transverse diameter. Patients' height showed persistent correlation with luminal diameter.

Primary Pulmonary Lymphoma: A Report of 2 Cases

PURPOSE: Primary pulmonary lymphoma(PPL) arising in the lung as the initial site is very rare. Authors experienced two cases of PPL and report the radiologic findings and clinical characteristics with a brief reviewof the literature. METHODS AND MATERIALS: Plain chest radiograph and enhanced axial CT scan of the chest were taken. We analyzed radiologic findings of the two cases and correlated with broncoscopic and pathologic findings. RESULTS: Plain chest radiograph showed a mass like consolidative lesion on RML without peripheral atelectasis. Chest CT scan revealed a mass like consolidation with airbronchogram and the absence of a hilar mass or thoracic adenopathy. Percutaneous needle aspiration and biopsy(PCNA and PCNB) of the RML mass confirmed B-cell lymphoma, in both cases. CONCLUSION: PPL must be included in the differential diagnosis of chronic alveolar consolidation such as bronchioloalveolar cell carcinoma.

A study on development of social health assessment tool and health status of Korean elderly / 성인간호학회지

No abstract available.

A study on the development of physical health assessment tool and health status of Korean elderly / 성인간호학회지

No abstract available.