Validation of the Shock Index, Modified Shock Index, and Age Shock Index for Predicting Mortality of Geriatric Trauma Patients in Emergency Departments

The shock index (SI), modified shock index (MSI), and age multiplied by SI (Age SI) are used to assess the severity and predict the mortality of trauma patients, but their validity for geriatric patients is controversial. The purpose of this investigation was to assess predictive value of the SI, MSI, and Age SI for geriatric trauma patients. We used the Emergency Department-based Injury In-depth Surveillance (EDIIS), which has data from 20 EDs across Korea. Patients older than 65 years who had traumatic injuries from January 2008 to December 2013 were enrolled. We compared in-hospital and ED mortality of groups categorized as stable and unstable according to indexes. We also assessed their predictive power of each index by calculating the area under the each receiver operating characteristic (AUROC) curve. A total of 45,880 cases were included. The percentage of cases classified as unstable was greater among non-survivors than survivors for the SI (36.6% vs. 1.8%, P < 0.001), the MSI (38.6% vs. 2.2%, P < 0.001), and the Age SI (69.4% vs. 21.3%, P < 0.001). Non-survivors had higher median values than survivors on the SI (0.84 vs. 0.57, P < 0.001), MSI (0.79 vs. 1.14, P < 0.001), and Age SI (64.0 vs. 41.5, P < 0.001). The predictive power of the Age SI for in-hospital mortality was higher than SI (AUROC: 0.740 vs. 0.674, P < 0.001) or MSI (0.682, P < 0.001) in geriatric trauma patients.

Factors Affecting Loneliness in Community Dwelling Korean Elders / 기본간호학회지

PURPOSE: This study was done to investigate the relationship of family function, self-esteem, life satisfaction, and general characteristics to loneliness in community dwelling Korean elders and identify factors affecting loneliness. METHOD: With a cross-sectional causal-relationship design and a convenience sample, 205 elders residing in three districts of the city of Seoul, S. Korea were recruited. Participants were assessed using the Family APGAR Score, Self-Esteem Scale, Life-Satisfaction Scale, and Revised UCLA Loneliness Scale. RESULTS: The mean score for degree of loneliness (Mean=39.61, SD=10.09) was just below the mean for the scale (Possible range 20-80). Loneliness had significant negative correlations with family function (r= -.400, p<.001), self-esteem (r= -.399, p<.001), and life satisfaction (r= -.644, p<.001). Other general characteristics that had significant or nearly significant relationships with loneliness were perceived current financial and health status, whether doing any exercise or physical activities, degree of close relationship with family members, and length of living in current residence. Among variables, life satisfaction (Standardized beta = -.589, p<.001) and length of living in current residence (Standardized beta = -.136, p<.05) significantly predicted degree of loneliness. CONCLUSION: Findings of this study allow a comprehensive understanding of loneliness and related factors among community dwelling elders in Korea. However, further studies with a larger random sample from various living environments are necessary.

Nursing Need of Patients with Chronic Illness: A Primary Study for Development for the Nursing Center of Chronic Illness / 간호학회지

PURPOSE: The purpose of this descriptive study was to identify the nursing needs of patients with chronic illness. METHOD: The subjects of this study were 636 patients with chronic illness, 323 general nurses, and 106 public health nurses. The instruments used for this study were questionnaires including perceived functions of nursing from the center for chronic illness, preference to placement, intention to use, needs to receive services from the center for chronic illness, strategies management for nursing, and nursing needs of chronically ill patients. RESULTS: The mean of perceived functions for nursing from the center were 3.1(0.5) in public health nurses, 2.9 (0.59) in general nurses, and 2.4(1.33) in chronically ill patients. Regards of needs to receive on services of the nursing centers were, the regularly physical examination, for health educational services which was perceived highest request amongst chronically ill patients. We found the means of each specific need as 2.2(0.6), for physical health, 2.1(0.7), for psychosocial health, and 1.8(0.6) for spiritual health. CONCLUSION: From the results of this study, it is suggested that establishing a nursing center for chronically ill patients consider physical, psychosocial, for spiritual health needs of chronically ill patients. It is also a consideration that direct care for symptom management and health education in the nursing center be implemented.

High Grade MALT Lymphoma of the Ileum in a Child Presenting as Intussusception: A Case Report

Lymphoma is the third most common childhood malignancy after leukemia and brain tumor. In contrast to adult non-Hodgkin's lymphoma, that occurring in children is usually found extranodally. The most common site is the abdomen, including the gastrointestinal tract, kidney and pancreas, and the next most common is the extranodal head and neck. Gastrointestinal non-Hodgkin's lymphoma in adults is usually considered to be MALT lymphoma, a distinct B-cell type, but the occurrence of this variety in the small bowel of children is relatively rare. We report a case of high-grade MALT lymphoma occurring in a nine-year-old boy who presented with ileoileal intussusception.

US and MR Imaging of Candidiasis of the Nervous System in Premature Infants: Two Case Reports

Candidiasis of the central nervous system (CNS) is a rare condition and like other opportunistic fungal infections, most commonly occurs in immune-compromised patients. Because of the increasing use of antibiotics and the improving survival rate of premature infants requiring intensive care, the incidence of fungal infections in the brain has increased. We report the findings of ultrasonography and MR imaging in two cases of candidiasis of the CNS in premature infants.

A Prediction Model for Stage of Change of Exercise In the Korean Elderly: Based on the Transtheoretical Model / 간호학회지

The purpose of this study was to identify causal relationships among variables of transtheoretical model for exercise in the elderly. A predictivel model explaining the stage of change was constructed based on a transtheoretical model. Empirical data for testing the hypothetical model was collected from 198 old adults over 60 years old in a community setting in Seoul, Korea in April and May,1999. Data were analyzed by descriptive statistics and correlational analysis using pc-SAS program. The Linear Structural Modeling (LISREL) 8.0 program was used to find the best fit model which predicts causal relationship of variables. The fit of the hypothetical model to the data was X2=132.85. (df=22, p=.000). GFI=.88, NNFI=.35, NFI=.77, AGFI=.59 which was not favorable but the fit of modified model to the data was X2=46.90. (df=27, p=.01).GFI= .95, NNFI=.91, NFI=.92, AGFI=.87) which was more than moderate. The predictable variables of stage of change for exercise of the Korean elderly were helping relationship, self cognitive determination, conversion of negative condition in process of change and efficacy for exercise . These variables explained 68% of stage of change for exercise of the Korean elderly.

Process of Change Corresponding to the Stage of Change of Exercise in Elderly / 간호학회지

Purpose: This study was performed to identify the factors that change exercise behave. This study will also classify and identify the characteristics of excercise stages to which the elderly belong Also, to identify the processes of change which influence on the changes in exercise performed by the elderly. Methods: Convenient samples of 198 subjects over the age 60 in Seoul Korea(mean age=70) were selected from elderly communities and were all mentally conpetant older adults. The data were collected from April 1,1999 to May 30, 1999. The research instruments were measured the change in exercise (Marcus et al., 1992b), such as Stage of Change measure(Marcus et al,1992a). The data were analyzed by SAS Program. Results: 1. According to the measure of change without missing data, 191 subjects were distributed each stage of change for exercise: 50 subjects (26.1%), 7 subjects (3.6%), 52 subjects (27.2%), 4 subjects (2%), and 78 (40.8%) belonged to the precontemplation stage, the contemplation stage, the preparation stage, the action stage and the maintenace stage. 2. According to the factor analysis, 6 factors of change were identified as appropriate processes of change and were named by the researchers. The names were; 'Supportive helping relationship', 'Self cognitive determination', 'Environmental reinforcement', Consciousness raising', Reinforcement of negative condition and 'Conversion of negative condition'. 3. According to the stage of change, there were significant mean differences in the 'Supportive helping relationship(F=22.04, p=.0001)', 'Self cognitive determination (F=50.87, p=.0001)', 'Reinforcement of negative condition(F=7.84,p=.0006)'. 4. Through the discriminant analysis, it was found that Self cognitive determination is the most influential variable as one of the processes of change which can discrimiate the three stages of change (precontemplation, preparation, and maintenance). Also the next significant variable was Reinforcement of negative condition. Conclusion: The process of the dey change is one of concepts of The transtheoretical model known as strategies and the techniques people use as they go through the different stages of change. Even though this study is cross- sectional not longitudinal study, the finding of this study gives useful information for exercise intervention, by using this strategy of exercise for elderly in different stages of change in exercise.

A Prediction Model for Stage of Change of Exercise In the Korean Elderly: Based on the Transtheoretical Model / 간호학회지

The purpose of this study was to identify causal relationships among variables of transtheoretical model for exercise in the elderly. A predictivel model explaining the stage of change was constructed based on a transtheoretical model. Empirical data for testing the hypothetical model was collected from 198 old adults over 60 years old in a community setting in Seoul, Korea in April and May,1999. Data were analyzed by descriptive statistics and correlational analysis using pc-SAS program. The Linear Structural Modeling (LISREL) 8.0 program was used to find the best fit model which predicts causal relationship of variables. The fit of the hypothetical model to the data was X2=132.85. (df=22, p=.000). GFI=.88, NNFI=.35, NFI=.77, AGFI=.59 which was not favorable but the fit of modified model to the data was X2=46.90. (df=27, p=.01).GFI= .95, NNFI=.91, NFI=.92, AGFI=.87) which was more than moderate. The predictable variables of stage of change for exercise of the Korean elderly were helping relationship, self cognitive determination, conversion of negative condition in process of change and efficacy for exercise . These variables explained 68% of stage of change for exercise of the Korean elderly.

Process of Change Corresponding to the Stage of Change of Exercise in Elderly / 간호학회지

Purpose: This study was performed to identify the factors that change exercise behave. This study will also classify and identify the characteristics of excercise stages to which the elderly belong Also, to identify the processes of change which influence on the changes in exercise performed by the elderly. Methods: Convenient samples of 198 subjects over the age 60 in Seoul Korea(mean age=70) were selected from elderly communities and were all mentally conpetant older adults. The data were collected from April 1,1999 to May 30, 1999. The research instruments were measured the change in exercise (Marcus et al., 1992b), such as Stage of Change measure(Marcus et al,1992a). The data were analyzed by SAS Program. Results: 1. According to the measure of change without missing data, 191 subjects were distributed each stage of change for exercise: 50 subjects (26.1%), 7 subjects (3.6%), 52 subjects (27.2%), 4 subjects (2%), and 78 (40.8%) belonged to the precontemplation stage, the contemplation stage, the preparation stage, the action stage and the maintenace stage. 2. According to the factor analysis, 6 factors of change were identified as appropriate processes of change and were named by the researchers. The names were; 'Supportive helping relationship', 'Self cognitive determination', 'Environmental reinforcement', Consciousness raising', Reinforcement of negative condition and 'Conversion of negative condition'. 3. According to the stage of change, there were significant mean differences in the 'Supportive helping relationship(F=22.04, p=.0001)', 'Self cognitive determination (F=50.87, p=.0001)', 'Reinforcement of negative condition(F=7.84,p=.0006)'. 4. Through the discriminant analysis, it was found that Self cognitive determination is the most influential variable as one of the processes of change which can discrimiate the three stages of change (precontemplation, preparation, and maintenance). Also the next significant variable was Reinforcement of negative condition. Conclusion: The process of the dey change is one of concepts of The transtheoretical model known as strategies and the techniques people use as they go through the different stages of change. Even though this study is cross- sectional not longitudinal study, the finding of this study gives useful information for exercise intervention, by using this strategy of exercise for elderly in different stages of change in exercise.

Perianal Episiotomy Scar Endometrioma: A Case Report

Endometrioma is a common clinical condition, but cases in which an episiotomy scaris present are, however, rare: only two cases have been reported in obstetric journals, and one other in a radiologic journal. All three were in English. We encountered a case in which a solitary endometrioma was present in the perineal region beneath an episiotomy scar. An irregularly marginated hypoechoic mass was revealed by US, and a discrete homogeneous enhancing mass by CT.

Decisional balance corresponding to the Stage of Change of Exercise in Elderly / 성인간호학회지

PURPOSE: This study was carried out to identify the factor of decisional balance for exercise. This was composed of a set of variables at the level of decision making when the elderly decide to do exercise. It was used to classify and identify the characteristics of the stages of change for exercise to which the elderly belong, and was used to identify the variables of decisional balance which influence the stage of change for exercise in the elderly. METHODS: Convenient samples of 198 subjects over age 60 in Seoul( mean age=70) were selected from community living, mentally competant older adults and the data was collected from April 1, 1999 to May 31, 1999. The research instrument was the Decisional Balance Measure for Exercise(Marcus &Owen., 1992), Stage of Change Measure(Marcus et al,1992). The data was analyzed by SAS Program. RESULTS: 1. According to stage of change measure, without missing data,191 subjects were distributed in each stage of change for exercise: 50 subjects(26.1%), 7 subjects (3.6%), 52 subjects(27.2%), 4 subjects(2%), and 78(40.8%) belonged to the pre- contemplation stage, contemplation stage, preparation stage, action stage and maintenace stage. 2. Factor analysis identified 3 factors of decisional balance as appropriate factors for exercise of the elderly and named by researchers; 1)'Perceived Physical-psychological benefit', 2)'Perceived Physical-psychological burden', and 3)'Perceived time burden'. 3. The analysis of variance showed that the two components Perceived Physical - psychological benefit(F=45.95, P=.0001), and Perceived Physical-psychological burden (F=26.52, P=.0001) were significantly associated with stage of change. 4. Through the discriminant analysis, it was found that both 'Self Perceived Physical - Psychological benefit' and 'Perceived Physical-Psychological burden' were the influential variables in discriminating the three stages of change(pre-contemplation, preparation, and maintenance). CONCLUSION: Results are consistent with the application of the Transtheoretical model, which has been used to understand how people change health behaviors. Even though this study is a cross-sectional, not a longitudinal study, the findings of this study give useful information for exercise intervention about especially the factors relating to decision making for exercise of the elderly in the different stages of change of exercise.

Tuberculous Aneurysm of the Abdominal Aorta: Endovascular Repair Using Stent Grafts in Two Cases

Tuberculous aneurysm of the aorta is exceedingly rare. To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication. Only recently has the use of a stent graft in the treat-ment of tuberculous aortic aneurysm been described in the literature. We report two cases in which a tuberculous aneurysm of the abdominal aorta was success-fully repaired using endovascular stent grafts. One case involved is a 42-year-old woman with a large suprarenal abdominal aortic aneurysm and a right psoas abscess, and the other, a 41-year-old man in whom an abdominal aortic aneurysm ruptured during surgical drainage of a psoas abscess.

Optimal Scan Time of Dual-phase Spiral CT in Normal Rabbit Liver: Effect of Contrast Injection Rate

PURPOSE: To determine the effect of contrast injection rate on rabbit liver enhancement and the optimaltem-poral window for dual-phase spiral CT of rabbit liver at each injection rate. MATERIALS AND METHODS: Usingspiral CT, seven New Zealand White rabbits underwent dynamic scanning at one level of liver. Three protocols ofcontrast injection rates were employed, namely 0.3 ml/sec(group 1), 1ml/sec(group 2) and 2 ml/sec(group 3). During120 seconds of total scan time, the scan interval was 3 seconds. Densities of the aorta, liver and portal veinwere averaged in equivalent time. The different injection rate protocols were compared for peak enhancement/timeon a time density curve. RESULTS: Mean peak enhancement (HU) in equivalent time(secs) was 310/18(group 1),383/9(group 2) and 357/6(group 3) in the aorta ; 34/36, 40/36 and 41/30 in the liver ; and 135/36, 153/24 and170/21 in the portal vein. The temporal window during the arterial phase was 12-21 sec(group 1), 6-12 sec(group2), and 6-12 sec(group 3). The temporal window during the portal phase was from 30 sec(0.3ml/sec), 21sec(1ml/sec)and 21 sec(2 ml/sec). CONCLUSION: During dual-phase spiral CT, the temporal window for liver scanningshould be determined according to each contrast injection rate. A slow contrast injection rate prolongs thetemporal window during the arterial phase.

Analysis of Current Adult Nursing Curriculum Content in Baccalaureate and diploma Levels / 성인간호학회지

The purpose of this study was to analyse the current adult nursing curriculum content in diploma and baccaleurate level nursing schools. The Study was initiated by the Korean Academic Society of Adult Nursing and data were collected from these institutions from March 1997 to April 1998. The questionnaire was constructed after several meetings of researchers which included course description, objectives, conceptual framework, credits(theory and practicum), number of teaching staffs, content and hours for each content. The questionnaire was sent to all of the nursing schools(41 baccalaureate and 62 diploma) in the nation and the response rate were 53.7% in baccalaureate and 25.8% in diploma schools. Primary analysis was took place during summer workship of 1997 Korean Academic Society of Adult Nursing. The second analysis was carried out after additional data of detailed content and hours in adult nursing course were obtained from the schools. The result of primary analysis were as below : 1) The consensus in philosophy of adult nursing was drawn. The client of adult nursing was defined as individual over 18 years who has psychological, physical, social and spiritual aspects and interacting with environment. The client is a member of family and community. The students who finished the course should be able to adapt nursing process to their clients, and improve quality of life. The client, nursing process and nursing were common concepts which included in their conceptual framework. 2) Theory credits ranged 9-18(mean 14.1), practicum credits ranged 5-12(mean 8.1). The number of teaching staffs ranged from 2-6(mean 3.2). 3) The content which most hours assigned to were neuro/endocrine(mean 30.8 hours) gastrointestinal(mean 28.4 hours), cardiovascular(mean 28.6 hours) and respiratory(mean 22.7 hours) systems. 4) Areas taught by other profession(mostly physician) were eye, ear, nose, throat integumentary, radiation therapy, neuromuscular, rehabilitation, respiratory physiology, male genitourinary, pathology and anesthesiology. 5) Contents overlap with other course content should be rearranged in each school curriculums. Improvement of RN national board examination is prerequsite in order to improve adult nursing education in Korea. The result of second analysis were as below : 1) Credits required for graduation were 130-175 in baccalaureate, 93-134 in diploma. Thirteen to Twenty-eight percent of total credits required for nursing major were credits of adult nursing. 2) Mean hours of total adult nursing lecture were 217 in baccalareuate and 212 in diploma. 3) Disease process occupied more hours than nursing process in adult nursing theory. It is suggested to include all nursing educational institutions in order to complete the survey, to delineate the core contents of adult nursing and rate of hours between theory and practise by Korean Academic Society of Adult Nursing.

Early Periventricular Leukomalacia: MRI and Ultrasonographic Correlation on First one Month of Life

PURPOSE: To compare the findings of early periventricular leukomalacia on MR imaging and on US. MATERIALS AND METHODS: MR imaging was performed in 17 neonates in whom well-demarcated increased periventricular echogenicity was seen on sonography. One more patient was included during the same period because MR imaging of this patient showed a periventricular lesion not suspected on previous US. Initial sonography was performed within 6 days of birth and was followed up between one week and one month later. MR images were obtained within the first month of life. RESULTS: Twelve of 17 neonates showed abnormal periventricular signal intensities on MR imaging. Follow up sonography revealed cystic changes in two cases and heterogeneous hyperechogenicities in three. All patients except the two with cystic changes showed normal periventricular echogenicity on final sonography, On MR imaging,11 cases showed multifocal periventricular increased signals on T1-weighted images, and two cases showed mainly decreased signals representing cysts. Positive findings were more evident on T1-weighted than on T2-weighted image. CONCLUSION: on T1-weighted imaging, the characteristic finding of early periventricular leukomalacia was multifocal periventricular hyper or hypointensities, and hyperintense lesions were more common than hypointense. In the diagnosis of early noncystic periventricular leukomalacia, MR imaging was more objective than US.

Cerebral Fat Embolism Syndrome: Clinical, CT and MR Findings

PURPOSE: CT and MR findings of cerebral fat embolism syndrome(CFES) have been rarely reported, because its diagnosis had been made on the basis of only clinical features in the majority of the cases. The purpose of this study is to describe the clinical, CT, and MR findings in six patients of CFES. MATERIALS AND METHODS: Brain CT and MR findings were retrospectively analyzed in six patients with CFES that was diagnosed on the basis of clinical and MRI findings. All six patients had long bone fractures and showed typical delayed clinical manifestations 2-3 days later. Both CT and MRI were examined in all of six patients. Initial CT scan was performed within 48 hours after trauma in all patients, andfollow-up CT scan was done in 2-11 days in two patients. MRI was done within 2-7 days after trauma in three patients, and 13 days, 18 days, and 45 days in other three patients. Follow-up MRI studies were performed in 2-60 weeks in four patients. Clinical and laboratory findings were analyzed retrospectively with medical records. CT and MRI findings were evaluated with regard to presence or absence of diffuse brain swelling and focal abnormalities of signal intensity(density). RESULTS: CT scans obtained within 2 days after trauma showed diffuse cerebral swelling in five patients and normal findng in one patient. On Tl-weighted MRI, diffuse cerebral swelling was shown in three cases and high signal spots suggesting cerebral petechial hemorrhage were noted in both caudate nuclei and thalami in two cases. On T2-weighted images, high signal spots which were shown on Tl-weighted image were not visible. In all of six cases, multiple lesions of high signal were observed mainly in the cerebral white matters, cerebellum and brain stem, probably representing ischemia/infarct or edema. On the follow-up MRI studies performed within a period from weeks to one month after trauma, the size and the number of the lesions were significantly decreased and these findings were well corresponded with clinical course. CONCLUSION: MR findings' of CFES include diffuse cerebral swelling, petechial hemorrhage and mi- croinfarcts, which characteristically improved in short period. In cases suspected of having CFES, MRI is more useful than CT for initial and follow-up studies because of its high detection rate of lesions and correspondence with clinical course.

Leiomyoma and adenomyosis: US and MR findings

Leiomyoma and adenomyosis of the uterus are the most common gynecologic disorders in an enlarged uterus. The characteristic US and MR findings in differentiation between both lesions were prospectively evaluated in 30 patients. Of 30 patients, 15 were leiomyomas, 6 were adenomyosises, 8 were leiomyomas and adenomyosises, and 1 was a normal pregnancy, histologically. The total number of leiomyom nodules were 49 while adenomyosises were 14 (9 diffuse and 5 focal). Among 49 myomas nodules, 36 were correctly diagnosed by sonography. The characteristic US findings of uterine leiomyoma were well defined nodules (36), hypoechoic peripheral rim (16), and whorl-like internal echoes (13). Forty four of the 49 myoma nodules were correctly diagnosed by MRI. The characteristic MR findings of myoma were well defined nodules (43), peripheral low signal intensity rim on T1WI (13) and T2WI (9), and peripheral high signal intensity rim on T2WI (5). Among 14 adenomyosises, 9 were correctly diagnosed by sonography. The characteristic US findings of adenomyosis were diffuse uterine hypertrophy more than 5.5cm in AP diameter with endometrial displacement and no significant echo change in myometrium All 14 adenomyosis as were correctly diagnosed from MRI. On T2WI, adenomyosis appeared as ill defined localized or diffuse thickening of the junctional zone more than 1cm in thickness. It was our conclusion that to differentiate between leiomyoma and adenomyosis focused on should be the detection of existence of nodule in leiomyoma, the primary sign, not on the secondary indirect sign.

CT diagnosis of obturator hernia: report of 2 cases

No abstract available.

CT in the diagnosis of transitional cell carcinoma of the kidney

No abstract available.

Cavernous hemangioma in the kidney

Renal hemangioma is a rare benign tumor which usually causes unexplained painless gross hematuria with clotsin the renal pelvis or ureter. It isgenerally venous origin but may be arterial or mixed venoarterial; it may becapillary but is generally cavernous type which has predilection of submucosal, papillary,and medullary locations.It is very important ot include renal hemangioma in the diffrential diagnosis in cases of unexplained grosshematuria with clots in order to save the renal parenchyme. And preoperative selective renal angiography can offerhelpful diagnostic informations and may be helpful to decide surgical procedure. A case of surgically proven renalhemangioma is reported with a brief review of the literatures.