Development of Pediatric Patient Classification System / 임상간호연구

Purpose@#This study was performed to develop a valid and reliable Pediatric Patient Classification System (PPCS). @*Methods@#The study was conducted in a children’s hospital which included various ward settings.Content validity was analyzed by Delphi method and to verify intraclass correlation reliability, 7 nurse managers and 29 staff nurses classified 216 patients. To verify construct validity, the staff nurses classified 216 patients according to PPCS comparing differences by age, days of stay, type of stay and medical department. @*Results@#The developed PPCS has 12 categories, 55 nursing activities and 80 criterions. High agreement among nurses (r=.90) suggested substantial reliability. Construct validity was verified by comparing differences in age, days of stay, type of stay and medical department (p<.05). The entire patient group were classified to four groups using PPCS. @*Conclusion@#The findings suggest that PPCS would be a useful tool for estimating nursing demands related to medications and the complexity of pediatric patients.

Repetitive Transcranial Magnetic Stimulation for Limb-Kinetic Apraxia in Parkinson's Disease

No abstract available.

The Impact of a National Healthcare System on the Doctor-Patient Relationship in Neurology

No abstract available.

Apraxia: Review and Update

Praxis, the ability to perform skilled or learned movements is essential for daily living. Inability to perform such praxis movements is defined as apraxia. Apraxia can be further classified into subtypes such as ideomotor, ideational and limb-kinetic apraxia. Relevant brain regions have been found to include the motor, premotor, temporal and parietal cortices. Apraxia is found in a variety of highly prevalent neurological disorders including dementia, stroke and Parkinsonism. Furthermore, apraxia has been shown to negatively affect quality of life. Therefore, recognition and treatment of this disorder is critical. This article provides an overview of apraxia and highlights studies dealing with the neurophysiology of this disorder, opening up novel perspectives for the use of motor training and noninvasive brain stimulation as treatment.

Giant Arachnoid Granulations in Headache Mimicking Migraine with Aura

Giant arachnoid granulations have been reported to be associated with headaches, which can be acute or chronic in presentation. In some cases, idiopathic intracranial hypertension, previously called pseudotumor cerebri, may occur. The pathophysiology of these enlarged structures seen as filling defects on imaging is not clearly defined, although they are presumed to cause symptoms such as headache via pressure resulting from secondary venous sinus obstruction. We present a unique presentation of secondary headache in a 39-year-old man with no prior history of headaches found to have giant arachnoid granulations, presenting as migraine with aura.

Recurrent Aseptic Meningitis in Kikuchi-Fujimoto Disease: A Not So Benign Disease?

No abstract available.

Tremor in a Bassoonist: Tremor in Dystonia or Essential Tremor?

No abstract available.

Direct Thrombus Imaging in Stroke / 대한뇌졸중학회지

There is an emergent need for imaging methods to better triage patients with acute stroke for tissue-plasminogen activator (tPA)-mediated thrombolysis or endovascular clot retrieval by directly visualizing the size and distribution of cerebral thromboemboli. Currently, magnetic resonance (MR) or computed tomography (CT) angiography visualizes the obstruction of blood flow within the vessel lumen rather than the thrombus itself. The present visualization method, which relies on observation of the dense artery sign (the appearance of cerebral thrombi on a non-enhanced CT), suffers from low sensitivity. When translated into the clinical setting, direct thrombus imaging is likely to enable individualized acute stroke therapy by allowing clinicians to detect the thrombus with high sensitivity, assess the size and nature of the thrombus more precisely, serially monitor the therapeutic effects of thrombolysis, and detect post-treatment recurrence. This review is intended to provide recent updates on stroke-related direct thrombus imaging using MR imaging, positron emission tomography, or CT.

The Problem of Functional

No abstract available.

Cognitive Intervention in a Patient with Carbon Monoxide Intoxication

BACKGROUND: Cognitive intervention (CI) is a nonpharmacological approach used to compensate for cognitive impairment. It is categorized into cognitive training, cognitive stimulation and cognitive rehabilitation. Several studies showed that CI could induce cognitive enhancement and reduction of risk for future cognitive decline in patients with brain injury. We investigated effects of CI on cognitive functions and brain glucose metabolism based on serial cognitive assessments and [18F]-Fluorodexoxyglucose positron emission tomography (FDG-PET) in a patient with carbon monoxide (CO) intoxication. METHODS: A 40-year-old man presented with memory impairment and abnormal behaviors such as apathy, indifference, and perseveration 2-month after CO intoxication. Brain magnetic resonance image (MRI) demonstrated high signal changes in the bilateral basal ganglia, hippocampus and the subcortical white matter on T2 weighted images. FDG-PET also showed glucose hypometabolism in the bilateral hippocampus, basal ganglia, and the subcortical white matter. A detailed neuropsychological evaluation revealed multiple cognitive impairments in memory, language and frontal functions. He received twice a week sessions of 60-minute group-based cognitive intervention for 12 weeks. Several neuropsychological examinations and FDG-PETs were conducted at baseline and after CI. RESULTS: After CI, he showed improvements in memory and frontal functions compared with baseline performances. These cognitive improvements persisted by the 7-month follow-up. The extent of glucose hypometabolism was decreased 1-month after CI, however increased 8-month after CI. CONCLUSIONS: This case study suggested that CI could enhance cognitive functions and improve glucose metabolism in a patient with CO intoxication. Also, the effects of CI on cognitive functions seem to be last at least 7-month after training.

Neurologists' Awareness and Preparedness on Prion Diseases in Korea

BACKGROUND: Creutzfeldt-Jakob disease (CJD) is very rare human prion disease. But, neurologists take a key role in diagnosis, surveillance and management of the cases because of its complexity and difficulty in diagnosis of the disease. The aim of this study is to investigate the level of awareness and preparedness of Korean neurologists on this rare disease. METHODS: Survey sheets of self-administered questionnaire were given to Korean neurologists who participated in the 31st Annual Meeting of the Koran Neurological Association. Data from 133 respondents were conducted by descriptive analysis. RESULTS: Their answers were as follows: About 62% of neurologists have experienced patients of CJD. Forty-four percent of the patients were confirmed by brain biopsy. Most of neurologists (44%) were not confident to diagnose CJD and the reason why they felt hard to diagnose was due to the variable initial clinical manifestations (45.1%) and the lack of clinical experience (51.9%). Heidenheim variant CJD, proteinase sensitive prionopathy, molecular subtypes of sporadic CJD, diagnostic criteria was not familiar term to Korean neurologists (76.7%, 53.4%, 58.6%, and 62.4% respectively). Opinion for the most useful diagnostic tool was brain MRI (45.1%), CSF 14-3-3 protein (30.1%), typical EEG finding (36.8%) and gene (PRNP) test (42.9%). And they consider none of them are specific for the diagnosis of CJD (89.5%, 73.7%, 83.5%, 91.7%, respectively). Most of the neurologist in this survey answered that the opportunity for education of CJD should be increased (67.7%). CONCLUSIONS: Most of neurologists have encountered CJD patients although it is very rare disease. Some of the important and fundamental concepts of CJD were not correctly recognized to Korean neurologists, necessitating a persistent support for updating knowledge and information.

Hypersomnia as Presenting Symptom in Wilson's Disease

Wilson's disease shows considerably various symptoms that sometimes timely diagnosis is delayed when patient shows vague clinical presentation. We present a female patient whose initial symptom was hypersomnia and severe fatigue. She was initially diagnosed as depression. Because initial hepatic function test was unremarkable, it was not easy to come to think about relationship between hepatic function and hypersomnia. Her final diagnosis was Wilson's disease. This case suggested that hypersomnia otherwise unexplained could be the presenting symptom of Wilson's disease.

TnI, cTnT, and CK-MB in patients with chronic renal failure / 대한내과학회지

BACKGROUND: Nonspecific elevations of CK-MB, cTnT have been well known in patients with chronic renal failure(CRF) on maintenance hemodialysis. It has been suggested that recently developed cTnI seldom shows nonspecific elevations in these patients. Status of CRF patients can be divided into three groups: predialysis group, hemodialysis group and peritoneal dialysis group. Until now, most researchers have studied CK-MB, cTnT and cTnI only in CRF patients receiving maintenance hemodialysis. No previous studies have ever compared the differences of the nonspecific positivity of CK-MB, cTnT and cTnI according to the different status of CRF patients. METHODS: Nonspecific positive ratios of cTnI, cTnT, & CK-MB in were evaluated 20 predialysis patients, 13 CAPD patients and 20 hemodialysis patients. No one had had any evidence of myocardial ischemia during the previous 3 months before the study entry. The predialysis group was again divided into two groups according to the cut off level of serum creatinine of 3.0 mg/dl. Authors also compared the nonspecific positive ratios of cTnI, cTnT, CK-MB between diabetic CRF group and non diabetic CRF group. The sensitivity, specificity and false positive ratios of each enzymes were examined on and 6 hours after arrival in 21 CRF patients who visited the emergency room with the complaint of chest pain. RESULTS: 1) There were no nonspecific significant elevations of cTnI in CRF patients regardless of the status of CRF. But there were significant nonspecific elevations of CK-MB, cTnT in them. It was more marked in cTnT especially with the cut-off value of 0.1 ng/ml. 2) Nonspecific positive ratios of cTnT was significantly increased in diabetic CRF patients. 3) The sensitivity and specificity of cTnI were 100% and 93.3% each, which were significantly higher than those of CK-MB(83.3%, 66.7%) & cTnT(66.7%, 53.3%). CONCLUSION: In CRF patients, the nonspecific positive ratios of CK-MB, cTnT were higher than that of cTnI, and only cTnI did show significant specific elevations in all the CRF patients with acute myocardial infarction. It is likely that the status of CRF patients, dialysis mode, the sampling time point would not give significant changes in the nonspecific positive ratios of CK-MB, cTnT and cTnI.

[Sanitation measures in evidence of Legionella]. / Sanierungsmassnahmen beim Nachweis von Legionellen.

Appearance of Legionella disease generally is underrated. Conclusions as to disease frequency from Legionella antibody investigations are not reliable. The number of microbes necessary to produce illness depends from individual preliminary conditions. In special areas of the hospital the rate of diseases caused by Legionella can be reduced by protection. In bathing areas generally the hitherto existing regulations of the Federal Health Authority are sufficient: Continual warm water temperature increases from 60 degrees C, chlorination if necessary, regular stepwise controls. Insufficient results are produced by intermittent temperature increases. Filters that are impermeable for microbes appear uneconomical for bathing areas.

[Pneumonia in immunocompromised patients: the value of non-biopsy bronchoscopic examination procedures in the diagnosis of pathogens]. / Pneumonien bei abwehrgeschwächten Patienten: Stellenwert nicht bioptischer bronchoskopischer Untersuchungsverfahren in der Erregerdiagnostik.

Bronchoscopy was performed on 101 immunocompromised patients with fever and pulmonary infiltrates. Underlying diseases were mainly hematological malignancies. In 71% of cases, etiology of pneumonia was clarified by nonbioptic bronchoscopic methods (bronchoalveolar lavage, bronchial secretions, protected specimen brush). In 51% of cases, empirical antibiotic treatment was modified following bronchoscopy. In patients with early bronchoscopy a better prognosis regarding healing and survival was observed than in those cases, where bronchoscopy was performed later during pneumonia. Bronchoalveolar lavage was particularly suited for diagnosis of Pneumocystis carinii and pneumonia due to viruses or Legionella. Sensitivity and specificity of bronchoscopy were lower for diagnosis of mycotic pneumonia and of Gram-negative or Gram-positive bacteria.

[Aspects of hospital hygiene in Legionella infections]. / Krankenhaushygienische Aspekte der Legionella-Infektionen.

Legionella inevitably are imported from natural reservoirs into drinking-water supplies. Bacterial growth predominantly occurs at water temperatures between 40 degrees C und 50 degrees C (104 degrees F and 122 degrees F). Heat conduction to insufficiently insulated cold water tubes implies the possibility of increased contamination also there. Problems with contamination arise in parts of the water supplies with stagnant warm water. Therefore, reservoirs should be descaled regularly. In general, for prophylaxis are recommended raising the temperature of warm water to 60 degrees C (140 degrees F), regular microbiological control of water quality and regular technical maintenance of waterworks where warm water stagnates for some time. Patients bearing a higher risk of Legionella-infections require intensified precautionary measures. The diagnosis of legionellosis should be based on the direct evidence of immunofluorescence-stained microorganisms. Finding increased antibody titers alone is not always correlated with the response to Legionella-specific therapy.

Clinical Trial on the Hypotensive Effect of Arotinolol(S-596) in Essential Hypertension

Arotinolol was administered orally to 31 patients to evaluate is antihypertensive action. After one week of antihypertensive medication, they were given Arotinolol 30mg daily for 4 week. Routine serum chemistries, electrolytes, urinalysis and electrocardiography were studied before and after Arotinolol. Blood pressure measured in sitting, supine and standing position was 175.3+/-5.4/115.7+/-4.0, 168.0+/-5.2/150.0+/-3.8, 154.4+/-8.5/103.4+/-3.2mmHg in control and 143.8+/-2.8/93.3+/-2.8, 144.6+/-5.4/88.1+/-4.3, 139.7+/-4.6/86.8+/-3.4mmHg in Arotinolol treatment group. The differences between both blood pressure were statistically significant(P<0.01). No laboratory test showed significant difference between both period. There were no significant side effects except 2 cases of transient headache and dizziness respectively, and one case of diarrhea. In summary, Arotinolol apears to reduce blood pressure effectively with minimal side effects.

The importance of different laboratory methods in Legionella diagnosis in medical care.

Legionellae an infection by contaminated water is thought to be respo environment of patients with a high risk of infection (e.g. after ki lantation, immunosuppression) prophylactic measures (rising the tempe warm water to 60 degrees C) should be combined with bacteriological c s to be taken into account, however, that only by taking a couple of he same outlet during a period of time a colonization of central inst ms (sediments, storage tanks) can be discovered. In patients with acu a of unknown origin serological tests of Legionella antibodies are no c. Antibody titers of not infected and with Legionella infected patie gnificant difference. Well suited for the diagnosis of a legionellosi f the Direct Immunofluorescent Antibody Assay (DFA) in invasively sam . In immunocompromised pneumonia patients 18.3% of bronchoalveolar 6.0% of bronchoalveolar aspirates are Legionella positive. RETURN/proces t F3/ext F4/can F5/nxt F6/ins F7/up F8/dwn F9/fin lavages and 16.0% of bronchoalveolar aspirates are Legionella positive.