Perception of Patient Safety Risk Factors and Performance Level of Safety Care Activities among Hospital Nurses / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify the level of perception of safety risk factors and the degree of performance of safety nursing activities in order to develop an education program to improve the safety of patients. METHODS: The subjects were 217 nurses from 3 university hospitals in Incheon. Data were collected with structured questionnaires and analyzed using descriptive analysis, t-test, and ANOVA using SPSS 22.0. RESULTS: The level of perception of patient's safety risk factors and safety care activities was 2.93 and 4.68, respectively. Perception of patient safety risk factors which belonging to the risk type of therapeutic devices, equipment, service and infrastructure all scored below average; also in addition, behavior, performance, and violence risk type and work system, information and communication risk type showed relatively low perception levels. Safety nursing activities showed a low level of performance in accurate communication among medical teams, management of fire and disaster, security management, use of restraints, identification of patients, and correct performance of operations and procedures. CONCLUSION: Based on these results, it is necessary to improve the safety of patients by taking proper management measures along with education.

Non-Operative Management in Residual and Recurrent Bile Duct Stones

BACKGROUND: Residual and recurrent bile duct stones after biliary surgery cause many difficult problems. and reoperation on biliary tract has limitation due to its high morbidity and mortality. In recent years, various non-operative modalities for management in residual and recurrent stone have been developed. METHODS: We analyzed 69 cases of residual and recurrent bile duct stones which were managed with non-operative modalities at the Department of surgery, Dae Dong Hospital from Jan. 1994 to Dec. 1997, and evaluated the efficacy of these modalities. RESULTS: Female exceeded male with a ratio 1.76:1. and the peak incidence of age group was 6th decade. The most common diagnostic procedure was T-tube cholangiography (53.6%). Interval between previous operation and second procedure for residual or recurrent stones was within 6 months in most cases (82%). Cholecystectomy with T-tube choledochostomy was performed most frequently in previous operation. Residual and recurrent stones were found only at common bile duct in 34 cases (49.3%) most commonly. Common bile duct stones were managed most frequently with endoscopic sphincterotomy (39.5%), but the complete removal rate was heighest in choledochoscopic stone removal (100%). Complete removal rate of intrahepatic duct stone was heighest with interventional radiologic stone removal as well as choledochoscopic stone removal (43.6%), but average number of session was smaller in choledochoscopic stone removal (2.5) than interventional radiologic stone removal (3.5). Associated complication with non-operative management modalities were very low, except three cases of hepaticocutaneous jejunostomy. The latter required reoperation due to continuous bile fistula in two cases, and long jejunal loop in one case. CONCLUSIONS: Choledochoscopic stone removal is most effective method in the management of residual and recurrent bile duct stones.

Uncommon Causes of Small Bowel Obstruction

BACKGROUND: The major causes of small bowel obstruction (SBO) are postoperative adhesion, hernia, intussusception and malignancies. However, in cases of uncommon causes of SBO, surgeons are be in a dilemma because the preoperative diagnosis and the decision to operate are frequently difficult and delayed. METHODS: We reviewed retrospectively the cases of 29 patients with SBO who were operated on for unknown etiology at Daedong Hospital between Jan. 1, 1991, and Dec. 31, 1997. The common causes of SBO, such as postoperative adhesion, external hernia, congenital anomaly of the gastrointestinal tract in neonate, intussusception in children, and known intraabdominal malignancy, were all excluded. RESULTS: 1) The incidence of uncommon causes of SBO included in this study was 8.7% of all cases of SBO operated on during the same period. 2) Among the 29 cases, 12 cases were caused by tumors (41.4%), of which the number of malignant tumors was double that of benign ones. 3) Besides tumors, there were 3 cases of bezoar, two cases of congenital bands, mesenteric cysts, internal hernias, Meckel's diverticula, and intussusception, one case each of mesenteric panniculitis and Crohn's disease, and two cases with an unknown etiology of inflammation. 4) Five cases were due to adult intussusception, 3 cases of which were due to benign tumors of the small bowel. All of the SBOs by intussusception were located at the terminal ileum. 5) The most common site of obstruction was the ileum (20 cases), followed by the jejunum (7 cases), and the duodenum (2 cases). 6) Males were dominant (1.6:1) especially in cases of tumor-origin SBOs (2:1). 7) In viewing the age distribution, the incidence was relatively high in the 5th and the 8th decades. Especially, tumor-origin SBOs had their peak in the 5th decade, and all cases of bezoar were found in 8th decade. 8) Operations were performed within 72 hours in 19 cases (65.5%) after first inspection of the patients, and intussusception, congenital band, and bezoar were the common causes of the cases involved in early surgical intervention. 9) Segmental resection of the small bowel was the most common surgical procedure (19 cases, 65.5%), followed by bypass surgery (6 cases), removal of the bezoar (2 cases), and excision of the mesenteric cyst or band (1 case, respectively). Coclusions: We think it reasonable to perform an exploratory laparotomy in cases of unknown causes of SBO as early as possible because almost all the cases require surgical intervention eventually, and studies searching for the causes of obstruction will only be time-consuming. While surgeons should keep in mind that tumors are major causes of uncommon SBOs.

A case of Peutz - Jeghers syndrome with duodenal adenocarcinoma and obstruction / 대한내과학회지

Peutz-Jeghers syndrome is a rare autosomal dominant disorder defined by harmatomatous polyps of the gastrointestinal tracts and the occurrence of melanin spots on the lips(oral mucosa), hands and feet. This syndrome is associated with a variety of gastrointestinal and extraintestinal neoplasms, both benign and malignant. A 28-year old male was admitted to our hospital with abdominal pain and nausea for two months. He had melanin spots involving his lips, buccal mucosa, hands and feet. A small bowel series showed luminal obstruction at the forth portion of the duodenum. And abdominal CT scan showed target-like mass suggesting intussusception on the small bowel. On laparotomy, there was an annular constricting mass adherent to retroperitoneum with metastasis to preaortic lymph nodes. Palliative duodeno-jejunostomy was performed. The histologic finding disclosed signet-ring cell type adenocarcinoma.

Clinical Evaluation of Incisional Hernia

An incisional hernia is still one of the common complications of abdominal surgical procedures and is a significant source of morbidity. The exact incidence of incisional hernias has not been well defined, although a number of reports in the literature suggest that it is between 2% and 11%. Repair of incisional hernias is a common procedure from the surgeon's viewpoint. The authors evaluated the clinical data of 34 patients with incisional hernias at the Department of Surgery, Daedong Hospital, Busan, between January 1990 and December 1996. Incisional hernias were more common in females(9 men and 25 women), and the range of ages was 29 to 79. The incidence was highest in lower midline incisions. Some factors supposed to be associated with the development of incisional hernias were a lower midline incision, increased abdominal pressure, wound infection, reincision, and previous incisional hernia. Severe vomiting, abdominal distension, severe coughing, obesity, and pregnancy contributed to the increased abdominal pressure. An appendectomy was the most common preceding operation for the occurrence of an incisional hernia, although the incidence of appendectomies at the author's hospital was the highest of all other operations. The most frequent symptom or sign of the patients was mass or bulging at the previous operation site. Herniation occurred in 18 patients (52.9%) within 1 year after the preceding operation and herniorrhaphies were performed in 14 cases (41.2%) within 1 year after herniation. The size of hernia in 32 patients (94.1%) was less than 10 cm in diameter, and mesh was used in four patients (11.8%). The method of repair was determined by the size of the defect and by the tension around the defect. Postoperative follow up was made by telephone in 20 of the 34 patients. Among them, the authors were notified of two recurrent incisional hernias: One developed after an operation for mechanical obstruction due to an appendectomy. The other recurred at the lower midline incision for an operation due to rupture of the small bowel and was accompanied by wound infection.

Clinical Experiences in Malignant Melanoma

Malignant melanoma has shown a dramatic increase in its incidence in the last two decades in the western hemisphere, but it is still rare in Korea. We respectively reviewed the medical records of 10 melanoma patients who had been admitted to and treated at Daedong Hospital between January 1986 and December 1996. The age of the patients was between 26 and 81 (average 60). There were 4 men and 6 women, most often over the fifth decade of life. Malignant melanoma was common in the extremities, especially the acral portion of the lower extremities: 4 in the sole, 2 in the dorsum of the foot, 1 in the palm, 1 in the thumb, 1 in the neck, and 1 in the anus. The sizes of the melanoma were from 0.4 cm to 4.5 cm in diameter and depths of invasion were from 0.8 mm to 6 mm microscopically. According to the TNM staging of the American Joint Committee on Cancer, the distribution of the patients was one for IB, two for IIA, two for III, and four for IV. In one case, the staging was difficult. Wide excision with skin graft was carried out in six patients with a 2-cm excision margin. Another two patients were treated with a 1-cm excision margin. In the other two patients, the melanoma was found in the biopsy of the cervical lymph node and in the widely excised anus. Elective inguinal lymph node dissection was carried out around the femoral and the external iliac arteries in 3 patients whose inguinal lymph nodes were palpated during physical examination. One patient with an anal lesion was vaccinated with BCG, but without much benifit. One patient was treated with radiation and chemotherapy, but he suffered brain metastasis. Four patients with stage IV melanoma died due to metastasis to the brain or the iver. The others were being follow up. Supportive treatments were under investigation, therfore early detection followed by wide excision is the best way to obtain a better outcome in malignant melanoma.

Immunohisochemical Studies on Expression of Estrogen Receptor Related Protein ( ERD5 ) in Gastric Cancer

To evaluate the prognostic significance of ERD5 in gastric cancer, the frequency of their expression was examined by the immunohistochemical method in 70 cases of gastric cancer with alcohol-fixed, paraffin embedded specimens which were obtained surgically at the department of Surgery, Gyeongsang National University Hospital from October, 1990 to May, 1993. Correlations between ERD5 positivity and clinicopathological parameters were analysed with Student's t-test and Chi-square test, and the survival rate according to whether the ERD5 was present or not was evaluated with Kaplan-Meier analysis model. Of the 70 patients, 40 cases showed a positive rate for estrogen receptor and 27 cases(67.5%) were male and 15 cases(50%) were female. There was no significant difference between the ERD5 positive rate and sex distribution. In age distribution, the ERD5 positive rate was most high(67%) in the 5th decade, but it was not significant statistically. There was no significant difference between the ERD5 positive rate and the WHO pathologic classification. In Lauren's classification, the intestinal type of gastric cancer had a higher positive rate(69%) than diffuse type(50%). In Ming's classification, the expanding type(82%) of gastric cancer had a higher positive rate than the infiltrative type(50%). A statistically significant difference was found between the expanding type and infiltrative type(P<0.05). There were no significant differences between the ERD5 positive rate and the TNM staging or the degree of differentiation of cancer cells. There was no significant difference between the ERD5 positive rate and the serum CEA level. Of the 70 patients, the overall 5-years survival rate was 37 % and 5-years survival rate of positive ERD5 cases had a higher rate (38.4%) than negative cases (35.1%) but there was no statistically significant difference. In conclusion, the ERD5 positive rate was significantly high in the patient with expanding type of gastric cancer in Ming's classification and intestinal type of gastric cancer in Lauren's classification. But, there was no significant difference in the survival rates between the ERD5 positive group and the ERD5 negative group.

Diagnostic Value of Thallium-201 Scan in The Thyroid Nodule / 대한내분비학회지

To investigate diagnostic value of Thallium 201(T1-201) thymid scan in differentiating malignant nodule from benign, 135 patients with thyroid nodule were evaluated with Tl-201 thyroid scan, fine needle aspiration(FNA), clinical characteristics and laboratory data. Each had histological diagnosis after thyroidectomy. Tl-201 scan had a sensitivity of 67.3% and a specificity of 66.3% and FNA had sermitivity of 46.9% and specificity of 100% in predicting malignancy. As the size of thyroid nodule and age of patient incteases, diagnostic value of 11-201 thyroid scan was improved. In the thyroid nodules larger then 3cm, sensitivity, specificity and negative predictive value were 100%, 70% and 100%, reqectively. By cornbining Tl-201 throid scan and FNA, sensitivity had 91.8%. From the data we conclude that Tl-201 thyroid scan is valuable with adjuvant diagnostic method in differentiating malignant fmm benign thyroid nodule and treatment planning.

Considerations for problems and unusual findings in laparoscopic cholecystectomy

No abstract available.