• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.985-991
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• 2001

Objectives : The craniopharyngioma is a benign tumor located at least in part in the suprasellar cistern. However, the symptoms and signs from this tumor may be determined not only by the location of the tumor but also by its size and the age of the patient. The objective of our study is to analyze retrospectively the clinical manifestations of craniopharyngiomas with regards to tumor characteristics in children and adults. Material and Methods: Twenty-three patients(16 adults, 7 children) treated for craniopharyngioma between 1990 and 1999 were studied to demonstrate the relationship of tumor size, growth pattern, and its invasiveness with clinical symptoms. As part of the assessment, 16 adults(M : F=8 : 8, mean age : 43.7 years) and 7 children(M : F=5 : 2, mean age : 10.1 years) underwent magnetic resonance(MR) imaging and computerized tomography(CT) scanning with a three-dimensional volume acquisition sequence. Results : The three major cardinal signs were defined to increased intracranial pressure, endocrine dysfunction, and visual problems. The tumor size in child group was larger than that in adult group. Also, visual problems, symptoms of increased intracranial pressure and hydrocephalus were more frequently observed in child group. However, endocrine dysfunction and neuropsychological symptoms related with hypothalamic connections to the thalamus, pituitary, frontal lobe, and other cortical areas were more frequent in adult group. Conclusions: In our series, the tumor size and invasiveness of craniopharyngioma revealed to be relevent with initial symptoms of increased intracranial pressure and visual symptoms which were more frequent in child group. As for the growth pattern, we did not find major difference between adults and children.

• Investigative Magnetic Resonance Imaging
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• v.7 no.2
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• pp.124-131
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• 2003

Purpose : To reveal clinical usefulness of functional MRI (fMRI) using sensorymotor and language stimuli for demonstrating anatomic relationship between sensorimotor or language cortices and lesions in the planning of brain tumor surgery. Materials and Methods : This study included 12 right-handed patients with brain tumors in or around sensorimotor or language cortices. Eleven patients were evaluated with primary motor and sensory stimuli. Of these patients, six patients were also evaluated with language stimuli. One patient was evaluated with language stimuli only. For fMR imaging, a 1.5T scanner was used and the EPI BOLD technique was employed. For postprocessing image, the SPM99 program and a program made by our department was utilized. We evaluated whether sensorimotor and language stimuli activate sensorimotor and language cortices. And also, clinical efficacy of revealing anatomic relationship between cerebral cortices and lesions for planning neurosurgical operation were evaluated. Finally, we compared post-operative neurologic function with pre-operative neurologic function in same patients. Results : The fMRI examination was successful in identifying the functional cortices and depicting anatomic relationship between functional cortices and lesions in all patients. In nine patients of 11 patients with identified sensorimotor cortices, postoperative grade of manual motor test was not changed, compared with preoperative grade. Whereas postoperative improved than preoperative grade in one patient of remaining two patients, postoperative aggravated than preoperative grade in the other. This result was due to atherosclerotic lacunar infarction, regardless of tumor resection. Postoperative deficit of language function was not found in seven patients with identified language cortices. Conclusion : fMRI could be a helpful method for determining the best approach to neurosurgical treatment in patients with brain tumors in or around sensorimotor or language cortices.

• Journal of the Korean Magnetic Resonance Society
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• v.5 no.2
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• pp.99-109
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• 2001

Authors investigated neuronal changes of local cellular metabolism in the cerebral lesions of Parkinsonian symptomatic side between before and after stereotactic neurosurgery by follow-up 1H magnetic resonance spectroscopy (MRS). Patients with Parkinson's disease (PD) (n = 15) and age-matched normal controls (n = 15) underwen MRS examinations using a stimulated echo acquisition mode (STEAM) pulse sequence that provided 2${\times}$2${\times}$2 ㎤ (8ml) volume of interest in the regions of substantia nigra, thalamus, and lentiform nucleus. Spectral parameters were 20 ms TE, 2000 ms TR, 128 averages,2500 Hz spectral width, and 2048 data points. Raw data were processed by the SAGE data analysis package (GE Medical Systems). Peak areas of N-acetylaspartate (NAA), creatine (Cr), choline-containing compounds (Cho), inositols (Ins), and the sum (Glx) of glutamate and GABA were calculated by means of fitting the spectrum to a summation of Lorentzian curves using Marquardt algorithm. After blindly processed, we evaluated neuronal alterations of observable metabolite ratios between before and after stereotactic neurosurgery using Pearson product-moment analysis (SPSS, Ver. 6.0). A significant reduction of NAA/Cho ratio was observed in the cerebral lesion in substantia nigra of PD patient related to the symptomatic side after neurosurgery (P : 0.03). In thalamus, NAA/Cho ratio was also significantly decreased in the cerebral lesion including the electrode-surgical region (P : 0.03). A significant reduction of NAA/Cho ratio in lentiform nucleus was not oberved, but tended toward significant reduction after neurosurgery (P = 0.08). In particular, remarkable lactate signal was noted from the surgical thalamic lesions of 6 among 8 patients and internal segments of globus pallidus of 6 among 7 patients, respectively. Significant metabolic alterations of NAA/Cho ratio might reflect functional changes of neuropathological processes in the lesion of substantia nigra, thalamus, and lentiform nucleus, and could be a valuable finding fur evaluation of Parkinson's disease after neurosurgery. Increase of lactate signals, being remarkable in surgical lesions, could be consistent with a common consequence of neurosurgical necrosis. Thus, IH MRS could be a useful modality to evaluate the diagnostic and prognostic implications fur Parkinsons disease after functional neurosurgery.

• Journal of Korean Academy of Nursing
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• v.17 no.3
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• pp.184-194
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• 1987

The purposes of this study were; 1) to gather data relevant to demographic features. major main management practices, and the level of impairment of the activities of daily living (ADL) of patients with back pain, 2) to test the sensitivity of the Korean Pain Rating Scale and the Graphic Rating Scales, and 3) to identify indirect indicators of back pain by analysing pain related-behaviors. The level of pain was measured by Korean Pain Rating Scale(KPRS) and Graphic Rating Scales(GRS) developed by the reserchers. The GRS consists of two dimensions; the pain intensity (sensory) and unpleasantness (affective) measures. Of the 1,650 diagnosed back pain patients, from January 4 through June 30, 1987 by visiting outpatients' clinics of orthopedic and neurosurgical departments at 11 university hospitals in different districts of Korea, 330 men and women patients were self-selected by responding to the mailed questionnaires. The results were summarised as follows: Male exceeded female patients in number and onset of back pain were more prevalent in the age groups of 20s and the 30s. The average duration of suffering from the pain were 11 months, sixty three (19.1%) of the subjects retired from their jobs, one third(36.7%) have teen hospitalized for the treatment of back pain. In two thirds(64.8%) of the cases pain was characterized as lower back pain. The average sleep hour was 6.8 hours per 24 hours and the average rest hour during the day was 3.3 hours. The mean percentage of pain measured by GRS was higher than that of KPRS. The level of sensory intensity as well as the affective level of pain measured by KPRS and GRS were not highly correlated (sensory intensity r=0.4986, affective r=0.5029) which indicated low discriminative power. On the other hand, intercorrelation between sensory and affective dimension measured by KPRS and GRS showed moderate interrelation(r=0.7247; r=0.7899). One-third(32.5%) of the subjects complied with the hospital prescribed treatment while the other one-third(31.5%) depended on self-remedy and traditional practices, and the last one-third did not imply any pain management practices. The following 6 pain-related behaviors such as length of hospitalization, rest hour during day hours, varieties of pain management practice implied, number of pain sites, need for ADL and discomfort accompanied by ADL revealed to be important indicators of back pain. An investigation of sociodemographic features of patients with back pain in a larger context, i.e. with bigger number of respondents is recommended. Tests for construct validity of KPRS, i.e. factor analysis is further recommended.

• Journal of Korean Academy of Nursing
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• v.13 no.3
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• pp.1-33
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• 1983

The role and function of nursing care nowadays, tend to acquire sophisicated technology because specialization has expended due to increase of the medical population and the improvement of national health standards. To implement nursing care independently as a professional nurse, the apprehension of specific knowledge and skill should be acquired during basic nursing education. So it is important for nursing education not only to include theory and actual techniques, but also to strengthen the practical training in the actual clinical setting. This study was carried out with the following objectives; 1. To survey the detailed content and frequency of actual nursing students display during their clinical training. 2. To investigate the detailed content and frequency of actual nursing behavior which students display in each clinical a area. 3. To identify the motive for selection of nursing as their major and to determine the degree of self confidence, extent of knowledge and recognition of nursing responsibility. 4. To observe the relationship between actual nursing behavior and each of the following; 1) Motive for selecting nursing as a major 2) Self confidence 3) Knowledge of nursing care 4) Recognition of nursing responsibility The conclusions of this study were as follows; 1. Among the detailed nursing behavior which junior nursing college students carry out in clinical training; taking respiration's showed the highest frequency, and taking body temperatures, blood pressures, and pulses and making beds were next in frequency in this order. 2. In detailed nursing behaviors according to clinical area; taking vital signs showed the highest frequency in the emergency room, pediatric ward, orthopedic ward, general surgical ward and internal medicine ward. However, in the operating room, assisting with endotracheal tube insertion and sterile techniques were showen to have the highest frequencies. In nursery, umbilical cord care and the measurement of body weight were the highest in frequency In neurosurgical ward, the measurement of vital signs, changing position and tracheostomy care were the highest in frequency. In obstetric and gynecological ward and in the delivery room, checking duration, intensity and frequency of contractions was the highest in frequency. 3. In regard to the motive for majoring in nursing, the aptitude and interest of the student had the highest percentage(32.86%), and self-confidence in nursing activities (M=3.36), knowledge in nursing activities.(M=3. 09), and the recognition of the nursing activity (M= 3.76) wire in the middle range. 4. When the detailed nursing behaviors were compared with motive, self confidence, knowledge and recognition, it was found that when the nursing behavior was difficult and regarding much endeavor although the motive was high, the frequency of the nursing behavior was rather low. But in the cases in which there was much self confidence and a high level of skill was required, nursing behavior was carried more frequently. When there was muck self confidence and skill was not required, the frequency of nursing behavior was rather low. In the cases of a high level of knowledge, the frequency of nursing behavior was low and when recognition for nursing behavior was given the frequency of nursing behavior was low.

• The Korean Journal of Rehabilitation Nursing
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• v.2 no.1
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• pp.72-84
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• 1999

The purpose of this study was to identify the effectiveness of bladder training on self voiding after removal of catheter in female patients with craniotomy, finally to develop a bladder rehabilitation program for cognitive impaired patients. Nonequivalent control group posttest design was used. The population of this study consisted of 34 hospitalized neurosurgical patients, all patients have been received craniotomy. 17 patients were assigned to the experimental group and another 17 patients to the control group. The homogeneity of general characteristics of the subjects was no significant difference. Bladder training program consisted of pre-training education, the bladder training, positive verbal reinforcement. The experimental group has been received bladder training and the control group has been received gravity drainage. The dependent variable, the frequency of voiding trial untill self voiding achieves, the frequency of urinary retention, the amount of residual urine, the occurrence, of urinary incontinence, were measured during 3 days after catheter removed. The data analyzed with SPSSWIN ; frequency, percentage, t-test and $X^2$-test were used to analyze homogeneity of general characteristics of subjects between the experimental and the control group. T-test, Mann-Whitney U test, and $X^2$-test were used to determine the effect of bladder training. The result of the study were as follows : There was significant difference in the frequency of voiding trial untill self voiding achieves between the experimental group and the control group. There was no significant difference in the frequency of urinary retention between the experimental group and the control group. There was no significant difference in the amount of residual urine between the experimental group and the control group. However, there was significant difference in the amount of residual urine in urinary retention patients. There was significant difference in the occurrence of urinary incontinence between the experimental group and the control group. In conclusion, bladder training program as a nursing intervention was effective in conclusion, bladder self voiding ability after removal of catheter for craniotomy patients. Therefore, it is recommended to use the bladder training program clinically for the bladder management of cognitive impaired patients.

• Korean Journal of Adult Nursing
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• v.12 no.2
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• pp.175-183
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• 2000

The study was done by applying a phenomenological study, which is qualitative research methods, in order to understand the meaning of the lived experiences, to confirm and describe the meaning structure, and to prepare nursing interventive strategies centering around the meanings of the inpatients' families in the intensive care units. In the study, the family members were the main important nursing providers for in the inpatients' who were admitted in the neurosurgical intensive care unit in K-university hospital and who agreed to participate in the study after being given on explanation about the purpose of the study. The data were collected from the seven participants who had feelings of trust and intimacy favorable toward the researcher as they were families of patients who had been cared for by the researcher in the ICU where the researcher has been assigned. The data were collected from April to October, 1999. The participants described their experiences as candidly as possible. The researcher described closely the lived experiences with their own words and the observations of the researcher. A tape recorder was used with the consent of the participants to prevent nursing information and communication. The analysis of the data was made through the phenomenological analytic method suggested by Giorgi; as an unit of description, which include the participants' expressions and the researcher's observations, the analysis was used based on the data described from the expressions of the participants and the details of observations of the researcher. The conclusions of the study were as follows : The meanings of the lived experience of the inpatients' families in the ICU was confirmed by indepth interviews and observations including these of the participatants : (1) Psychological impact: confusion, impatience, surprise, insensibility; (2) Physical suffering: fatigue, discomfort, indigestion; (3) Psychological suffering: heartbreaking emotion, anxiety, annoyance, fear, compassion, grief; (4) Economical suffering: economical difficulties; (5) Psychological disagreement: escape from reality, personnel avoidance, grudge, powerlessness, carefulness, transposition of life-tract, abandonment, role-crisis, hope, lack of understanding, regret, feeling of ambivalence(progressive process, medical personnel interest); (6) Psychological dependency; self-reliance group support, family support, religious support; (7) Psychological acceptance; acquaintance, gratitude, reassurance; The study will offer better understanding of experiences therefore, based on the experiences confirmed by the study, it may facilitate more appropriate nursing interventive strategies for health maintenance and to prevent occurrence of possible problems with the inpatients' families in the ICUs.

• Journal of Korean Academy of Nursing
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• v.23 no.2
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• pp.157-169
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• 1993

The most effective modality for cold application and the length of the application have not been determined despite many studies about the use of cold. A quasi-experimental study was conducted to examine the most effective modality among three methods of cold application, the most effective length of time for the application and the continuing effect after each type of cold application. Thirty adult patients admitted to medical and neurosurgical unit and with high fever (above 38.2 ℃) were assigned randomly to each of three cold ap-plication methods : (a) ice bag: (b) cold compress; and (c) tepid water sponge bath. Each method was applied to the whole anterior surface except the face and neck with the patient in the supine pos-ition. Rectal temperatures and skin temperatures (mid chest, upper arm, thigh and leg) were measured be-fore each application and every 10 minutes during ,each application for a period of 60 minutes. They were also measured every 10 minutes for 30 minutes after each cold application was finished. The experiments were carried out from Dec. 22. 1992 through Feb. 26, 1993. The data were analysed using means, ANCOVA Sheffe test and Pearson's Correlation Coefficient. The results of this study are as follows : 1. There were no significant differences among the three cold application methods in the reduction of body temperature, 2. Among the ice bag, cold compress and tepid water sponge bath groups, the ice bag proved to be the most effective method for lowering skin temperature while the cold compress was least effective. 3. Both rectal and skin temperature continued to decrease during the 60 minutes of cold application, but the hunting phenomena was not observed at any of the cold application sites. 4. There were no significant correlations between mean rectal and skin temperatures. 5. Skin temperatures according to the cold application sites decreased to a range of 3.46℃ to 5.20℃ (mid chest), a range of 4.48℃ 4.96℃ (upper arm), a range of 3.86℃ to 5.05℃ (thigh), and a range of 5.42℃ -7.12℃ (leg ). 6. In continuing effect after the cold applications were finished, rectal temperatures according to ice bag, cold compress and tepid sponge bath decreased to 0.29℃, 0.23℃ and 0.09℃ respectively, while the mean skin temperatures increased to 2.39℃ , 2.04℃ and 2.22℃ respectively. In this experiment the ice bag was the most effective modality for lowering skin temperature. when-ever cold is applied for systemic effect, the continuing effect of cold should be considered. The determination of the most effective length of time for cold application needs further study.

• Journal of Korean Critical Care Nursing
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• v.4 no.2
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• pp.27-38
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• 2011

Purpose: The purpose of this study was to examine the effect of tooth-brushing oral care on oral health and ventilator-associated pneumonia of patients in Intensive Care Unit (ICU). Methods: A total of 74 participants were recruited from a medical, surgical, or neurosurgical ICU at S Hospital in Seoul, Korea, from September of 2010 to January of 2011. An experimental group (n= 36) received oral care with tooth-brushing while a control group (n=38) received oral care with cotton ball and gauze. In both group, the oral care was done three times a day at least one minute for 7 days. Oral health was examined by the Modified Oral Assessment Guide before the intervention and each night. Results: There is no difference between the groups in aspect of passage of time (p = .603), interaction between time and intervention (p =.300), the performance intervention (p = .766), and the incidence of VAP (p = .486). Conclusion: The effect of oral care with tooth-brushing on oral health and VAP was not different from that of usual oral care in ICU. However, further study is necessary due to high attrition in this study.

• Journal of muscle and joint health
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• v.1 no.1
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• pp.97-115
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• 1994

The purpose of this study was to examine the reliability and validity of the observed behaviors of subjects who suffered from low back pain with spinal diseases, Thirty two low back pain patients admitted on the neurosurgical unit in an army hospital were compared with 30 normal controls belonged to an army unit, by means of matching the age, hight and weight. Observed pain behaviors were developed by the researcher on the bases of literature and patient observation. This tool consists of 18 behaviors seperated into two major groups : mutually exclusive and concomittent behaviors. The mutually exclusive behaviors included coding cathegories for 6. body motions assumed by the subjects during the observation session. These 6 standardized motions consisted of sitting from standing first, and serially tying down, reclining, sitting again, and then standing, 6 steps walking. Concomittent behaviors consisted of 12 observable patterns that can be observed systematically from the face, grimacing, bracing, rubbing, walking with arms fixed, support with hands on sitting or standing, guarded movement, limping, unbalaced weightbearing, stopped movement from tying position to sitting, sighing and graoning. Subjects were videotrecorded as they performed a 6-standardized sequence of motions, simultanously researcher measured the time spent performing each motion and step length. Patients were asked torate their subjective pain score on the 10 mm graphic rating scale ranging from 'no pain' to 'sever pain'. For scoring of the pain behaviors, two trained nursing officiers independently and simutanously viewwd each videorecording and checked subject 'pain behaviors at the observational item checklist. The result of the study are summarized as follows : 1. Reability of the observational tool was a=.845. 2. Spearman's rho and percentage agreement were p=.97 and 81.7 persent respectively, that indicate adequate interrater reability of this tool. 3. The sensitivity rate of the tool was .875 while specificity rate .866 for differentiating patient from the normal. 4. When difference in the objective pain indices between patient group and control were compared, there was significant difference of all indices, such as pain behavior(t=7.71, p=.0001). spent time performing motion(t=14.2, p=.0001), step length (t=-10.72, p=.0001). 5. There were differences in the objective indices the subjective pain subgroups (low, medium, high). Differences in the mean score of objective pain behavior (F=6.376. p=.005) and spent time for moyion(F=4.631, p=.018). But there were no significant differences in the step length among the subgroups(F=.667, p=.521). 6. Highly correlated pain behavior items wiyh subjective pain score were 'stopped movement from lying position to sitting', 'limping', 'support with hands on sitting or standing', 'bracing', 'guarding' and 'walking with arms fixed'. In summary, although some of rho behavior items such as sighing and groaning in this study could not be observed because of videotaped datd, the reliability and validity of the over all observation method were satifactory. Thus, the results of the present study demonstrate rye potetional utility of the tool in assessing objective pain complementing self-reported pain in low back pain patients.