• Journal of Hospice and Palliative Care
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• v.19 no.4
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• pp.303-309
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• 2016

Purpose: Malignant ascites is a common complication in terminal cancer patients. Less-invasive pigtail catheter insertion is the most frequent procedure in patients who need repeated ascites drainage. This study investigated effects and adverse events associated with catheter insertion for ascites drainage and evaluated prognostic outcomes. Methods: We reviewed medical records between 2010 and 2013 of hospice and palliative care institutions in Seoul, South Korea. Among 2,608 inpatients, 67 patients received ascites pigtail catheter drainage. We reviewed demographic data, palliative performance scale, laboratory data, duration of catheter insertion, prevalence and type of complications, use and duration of antibiotics, and survival time. Univariate and multivariate Cox regression models were used to evaluate prognostic outcomes related with catheter insertion. Results: Ascites drainage was performed most commonly in hepatobiliary and gastric cancer patients. Ascites symptoms improved in 55 patients after the catheter drainage. Adverse events included pain (19.4%), leakage (14.9%), disconnection (7.5%), catheter occlusion (6%) and fever (4.5%). In Cox regression analysis, survival time from the catheter insertion was significantly associated with Palliative Performance Scale (PPS) (HR 0.73; P value 0.045) and serum sodium level (HR 2.77; P value 0.003) in a multivariate model. Conclusion: Patients' PPS and serum sodium level should be considered before making a decision of pigtail catheter insertion.

• Advances in pediatric surgery
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• v.9 no.1
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• pp.45-51
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• 2003

A nationwide survey on choledochal cyst was undertaken among 39 members of the Korean Association of Pediatric Surgeons. The members were required to complete a questionnaire and the case registration form for each patient during the five year period of 1997 to 2001. Three hundred and forty eight patients were registered from 32 institutions. The average number of patients per surgeon was one to two every year. The male to female ratio was 1:3.4. The age of patients on diagnosis was $49.0{\pm}44.4$ months. The geographic distribution was 34.8% in Seoul and Kyoungki-do, 33.3% in Kyoungsang-do, 17.9% in Cholla-do, and 8.5% in Choongchung-do, in order of frequency. The three common clinical presentations were abdominal pain (63.8%), vomiting (35.3%), and jaundice (29.1%). Only seven patients (2%) presented with classic triad, and 25 patients were diagnosed by antenatal ultrasonographic examination. According to the Todani Classification, 238 patients (7l.3%) were type 1, 3 (0.9%) type 11, and 93 (27.8%) type IV. At the time of the operation, three important associated conditions were choledocholithiasis in 45 patients (15.1%), liver fibrosis (Grade 1-4) in 35, and previous operative procedure for biliary diseases in 10. Associated anomalies were observed in 13 patients (3.8%). Three hundred thirty nine (98.8%) of 343 lesions were treated by Cyst excision and Roux-Y hepaticoiejunostomy. One hundred seventy-six patients had an anomalous arrangement of the pancreatobiliary ductal system (APBD): APBD was not in 92 patients, biliary duct joined to the pancreatic duct in 51, and pancreatic duct joined to the biliary duct in 26. There were 8.5% early, and 7.7% late phase operative complications. The major complications were bleeding, anastomotic leakage, and acute pancreatitis. The combination of acute abdomen and choledochal cyst may suggest spontaneous rupture. Because of the development of late intrahepatic bile duct stones, long term follow up after cyst excision and hepaticojejunostomy is required. The optimal time of surgical intervention should also be considered in the situation of routine use of antenatal ultrasonographic examination. This is the first review of the choledochal cyst in Korea and provides baseline data for future comparisons.

• Sleep Medicine and Psychophysiology
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• v.4 no.1
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• pp.66-76
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• 1997

Objectives : The purpose of this study is to analyse sleep habits and sleep disorders in the elderly population ased 65-84 years. Methods : Epidemiological survey was performed at home by means of semi structured interviews in the city of Pusan, Korea. Subjects were randomly selected. The questionnaire consisted of 128 items including demographic findings, sleep habits, sleep disorders, somatic illnesses, and psychological distresses. Results : (1) The mean retiring time was 10.28 h (SD 1.30 h) and the mean wake-up time was 5.24 h (SD 1.33 h). The mean duration of sleep was 5.63 h (SD 1.80 h). The mean sleep onset time was 44.51 min. The mean frequency of daytime napping was 2.49 (SD 3.23). The subjects reported they woke up an average of 2.05 (SD 1.59) times per night. All of the above results were not related to age or gender. However, the mean frequency of difficulty in initiating/maintaining sleep was 2.2 times for men and 3.2 times for women (p<0.05). (2) The prevalence of insomnia was 57.7% and was not related to age or gender. Difficulty in initiating sleep was the most commonly reported insomnia complaint(52.4%). Early morning awakening was reported by 50.0% of patients and difficulty in maintaining sleep was reported by 45.1% of them. Worrying in bed and physical pain were strong contributing factor to insomnia. Conclusions : The results of our study showed several characteristics of sleep habits in the elderly. Sleep disorder in old age is not inevitable or trivial. Since sleep disturbance in older adults is common and distressing, it has implications for general health and well-being. Active concern and therapeutic intervention for the sleep habits and sleep disorders in the elderly are needed.

• Tuberculosis and Respiratory Diseases
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• v.64 no.5
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• pp.356-361
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• 2008

Background: We wanted to examine the clinical characteristics of adult patients with tracheobronchial foreign bodies (FBs) according to the risk of aspiration and the outcomes of intervention with using a fiberoptic bronchoscope. Methods: From December 1994 through December 2004 at Kyung Hee Medical Center, we retrospectively analyzed the medical records of 29 adult patients with FBs that were identified by using a fiberoptic bronchoscope. Results: 14 patients were not at risk of aspiration, whereas 15 had cerebrovascular diseases and they were at a high risk of aspiration. No history suggestive of FB aspiration was noted in 7 (24.1%) patients. Respiratory symptom(s) were noted in 22 patients, and these symptoms were cough (62.0%), dyspnea (44.8%), fever (20.7%), wheezing (13.8%), chest pain (10.3%) and hemoptysis (0.4%). Only 60% of those patients at a high risk of aspiration had symptom(s) (92.8% of those patients without a risk of aspiration had symptoms, p=0.005). Those patients at risk for aspiration had a longer duration of symptoms (median: 4 days vs. 2 days for those patients not at risk for aspiration, p=0.007) before diagnosis. Acute respiratory symptom(s) within 3 days after aspiration were more frequent in the patients without a risk of aspiration (9 vs. 4, respectively p=0.048). Chest x-ray revealed radiological abnormalities in 23 patients, and these were opacities suspicious of FB (n=11), pneumonia (n=8), air trapping (n=5) and atelectasis (n=3). There were no differences in radiological findings according to the risk of aspiration. FB aspiration developed most commonly during medical procedures (57.1% for the patients at risk) and during eating (35.7% for the patients without risk). The most common FB materials were teeth (n = 11). Alligator jaw biopsy forceps (n = 23) was the most commonly used equipment. All of the FBs were removed without significant complications. Conclusion: This study underlines that a tracheobronchial FB in the patients who are at a high risk of aspiration are more likely to overlooked because of the more gradual onset of symptoms and the symptoms develop iatrogenically in many cases.

• Journal of agricultural medicine and community health
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• v.30 no.1
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• pp.15-28
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• 2005

Objectives: The purpose of this cross-sectional study was aimed to investigate the status of bowel health behaviors, prevalence of constipation and risk factors related to self-reported constipation in high school students. Methods: The study subjects were 1,882 students of six high schools located in a metropolitan city, who were selected by the accidental sampling from June to August, 2002. We analyzed the data by frequency analysis, chi-square test, and multivariate logistic regression using SPSS ver. 10.0. Results: The result of this study were summarized as follows: 1. A prevalence rate of self-reported constipation was 25.2%. A rate in male students was 13.4% and in female students 36.5%. 2. In regard to therapeutic behavior, 52.1% of study student with change in bowel habit had not find particular counsellor, 38.9% of the student had counselling with parents. 16.3% of students in constipation group had taken laxative medicine for treating the constipation. 73.5% of the student in constipation group had suffered from anal pain during defecation, but 48.0% in normal group. 41.6% of the student in constipation group had a experience of rectal bleeding after defecation, but 23.7% in normal group. So constipation related symptoms distribution had showed statistically significant difference between two group. 3. From the multivariate analysis by self-reported method, the risk factors related to the constipation were sex(female), experience of diet for weight reduction, absence of the breakfast and intake of vegetable more than 3 times per weeks. Conclusions: we had reconfirmed that we should improve eating habits to prevent and treat the constipation in a result of this study. Intervention that is target to girl students, abstain from weight reduction diet, regularity of taking meals, intake more vegetables, stress management should be provided to prevent the constipation especially in Korean high school students. Further prospective designed study are needed to establish the causal-effect relationship between so many risk factors with constipation.

• Childhood Kidney Diseases
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• v.17 no.2
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• pp.101-109
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• 2013

Purpose: Pediatric urolithiasis is uncommon in children but is a cause of significant morbidity and damage to the kidney. Although much information on adult urolithiasis is available in the literature, large studies on the pediatric population are still scarce. In this report, we review our experience with pediatric urolithiasis over 22 years at a tertiary referral center. Method: We retrospectively reviewed the records of children with newly diagnosed urolithiasis between January 1991 and May 2013. We assessed the age, sex, family history, initial symptoms, location of stones, underlying cause, stone analysis, treatment, and recurrence among the patients. Results: In total, 137 patients (96 male, 41 female) were assessed. The age range was 0-17 years (mean age, 6.0 years). Forty-three (31%) children were aged <1 year, and 37% (16/43) had a history of intensive care unit (ICU) admission. Thirteen patients (9.5%) had a family history of stones. The most common symptoms at presentation among the patients were gross hematuria (56/137, 41%) and flank or abdominal pain (46/137, 34%). The stones were located in the kidney (85/137, 62%), ureter (29/137, 21%), bladder (2/137, 1.4%), and multiple locations (20/137, 15 %). Congenital abnormalities of the genitourinary (G-U) tract, with or without metabolic abnormality, or urinary tract infection (UTI) was detected in 26 children (19%). Ninety-one patients (66%) underwent metabolic examination, and 38% of these patients exhibited an abnormality. UTI, with or without abnormalities of the G-U tract, or metabolic abnormality was detected in 26 children (19%). Of the 35 stones analyzed, the majority were calcium stones (20/35, 57%), followed by infected stones (5/35, 14%), uric acid stones (4/35, 11%), carbonate apatite stones (3/35, 7%), cystine stones (2/35, 6%), and phosphate stones (1/35, 3%). Five patients (4%) required open procedures, with or without non-open procedures, whereas 77 patients (56%) were managed conservatively; the remaining 55 patients (40%) received some other form of intervention. Eighteen patients (13%) had stone recurrence during the follow-up period. Conclusions: Pediatric urolithiasis is commonly associated with abnormalities of the G-U tract and/or metabolic disorders and/or UTI. Half of the patients will pass their stones spontaneously, and all the techniques of minimally invasive surgery are applicable in the treatment of children with stones. As the recurrence rates are high among this population, long-term follow-up is recommended and the complete clearance of stones is important.

• The Korean Nurse
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• v.31 no.3
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• pp.76-87
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• 1992

The purposes of study was: 1. To identify the direction and scope of research activities in Korean Nursing. 2. To discuss the unique problems present in Korea that warrant nursing research. 3. To delineate the factors that facilitate and/or hinder nursing research in Korea. This study was conducted at six colleges of nursing in Korea. The schools which were selected had doctoral programs at the time, the data were collected in 1990. Four of the schools were located in the metropolitan area of the capital city, Seoul, and two were in two other cities similar in size. The total population of the study was 283 nurses. The instrument for the research was the English version of Research Profile Questionnaire which was translated into Korean by the researchers and was validated in its translation by two professors. A pretest procedure was done before the data collection process. Of the population of 283, 210 subjects received the questionnaire and 150 subjects responded(71.4%). Excluding incomplete questionnaires, 141 questionnaires were utilized for data analysis. Data were analyzed using descriptive statistics. Responses to open-ended questions were content analyzed for themes and categories. Results of the study were as follows : Respondents currently , involved in nursing research numbered 108(76.6%), but 33(23.4%) did not have any research experience. The inexperienced respondenLs tended to be younger than the experienced subjects and most( 60.6%) were employed in hospitals, while 82.4 percent of the experienced nurses were employed in nursing schools. Among the respondents with research experience, 68.5 percent were involved in one to three projects and 31.5 percent were engaged in four or more projects. The experienced nurses indicated that nursing research in Korea is active. On the other hand, the responses of the inexperienced were that nursing research is not active. The most frequently selected research subjects were patients(76.9%, 83 respondents) followed by nurses, healthy persons and nursing students. The relatively high percentage of healthy persons as study subjects, could be explained as a concern of nurses for healthy persons as well as for ill patients. The aforememioned literature review showed a dramatic change in the kinds of study subjects; approximately 33 percent were patients but 25 percent were healthy subjects of various ages. The hospital was the prevailing research setting(67.6%) but at the same time various community settings were used. This is a changing phenomena in nursing research of Korea. Current research designed to build on previous studies amounted to 75 percent; about 39.8 percem were theory and hypothesis generated. Over 65 recommended additional research focusing on hypothesis-testing 0:' theory building. The previously quoted literature review found that only 4.0 percent of the study quescions were developed from a theoretical framework. The most frequently listed current major focus of nursmg research was stress and adaptation. Patients with cancer, pain, social support and care of the elderly were the next most frequently reported. These concerns may reflect problems associated with a technological and industrializing societyl. The most frequently identified problem was lack of clinical research. The need for replication research and research that contributes to the accumulation of nursing knowledge were found to be rare in Korean research. A need for theory testing and theory construction research was also identified. Although advanced statistical methods were often utilized in nursing research, the results were frequently considered by the interviewers not to be applicable in practice, and readers had difficulty in comprehending the findings. Even though the number of clinical nurses involved in research is increasing, it is still considered inadequate. Among 108 respondents, 83(76.9%) gave lack of time as a barrier to conducting nursing research. Over fifty percent of the respondents reported lack of funding or, personally, low confidence in research skills as barriers. The respondents offered 183 suggestions for future emphasis in nursing research. Among the 51 areas of emphasis, clinical research received the highest number and nursing intervention was next. The findings suggested that nursing research should be based on theory, be related to practice and relevant to the situation of a unique Korean culture.

• Tuberculosis and Respiratory Diseases
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• v.45 no.5
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• pp.1058-1066
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• 1998

Background: Actinomycotic infection is uncommon and primary actinomycosis of the lung and chest wall has been less frequently reported. This disease may present as chronic debilitating illness with radiologic manifestation simulating lung tumor, pulmonary infiltrating lesion, or chronic suppuration. Diagnosis of choice was not definded yet and role of bronchoscopy on diagnosis was not described yet. Methods: From 1989 to 1998, we experienced 17 cases of thoracic actinomycosis. We have reviewed the case notes of 17 patients with thoracic actinomycosis. The mean age at presentation was $53{\pm}13$ years, 11 were male. Results: Cough, hemoptysis, sputum production, chest pain and weight loss were the commonest symptoms. The mean delay between presentation and diagnosis was $6.6{\pm}7.8$ months. There were six patients who presented with a clinical picture of a suppurative lesion and eleven patients were suspected of having primary lung tumor initially. In no cases was made an accurate diagnosis at the time of hospital admission. Associated diseases were emphysema (1 case), bronchiectasis (2 cases) and tuberculosis (2 cases). Bronchoscopic findings were mucosal swelling and stenosis(n=4), mucosal swelling, stenosis and necrotic covering (n=2), mass (n=3), mass and necrotic covering (n=1) and normal(n=6). Radiologic findings were mass lesion(n=8), pneumonitis(n=3), atelectasis(n=3), pleural effusion(n=2), and normal(n=3). Final diagnosis was based on percutaneous needle aspiration and biopsy (n=3), bronchoscopic biopsy specimens (n=9), mediastinoscopic biopsy (n=1) and histologic examination of resected tissue in the remaining patients(n=4) who received surgical excision. Among 17 patients, 13 were treated medically and the other 4 received surgical intervention followed by antibiotic treatment. Regarding the surgically treated patients, suspected malignancy is the most common indication for operation. However. both medically and surgically treated patients achieved good clinical results. Conclusion: Thoracic actinomycosis is rare. but should still be considered in the differential diagnosis of a chrinic, localized pulmonary lesion. Thoracic actinomycosis may co-exist with pulmonary tuberculosis or lung cancer. If the lesion is located in the central of the lung. the bronchoscopy is recommanded for the diagnosis.