Some tricuspid valve endocarditis can be controlled effectively with specific antibiotic treatment. However, surgical intervention Is necessary when there are continuing sepsis, moderate or severe heart failure, multiple pulmonary emboli, and echocardiographycally demonstrated vegitations. We are repoting a 19 year-old male patient who was admitted for the treatment of infective endocarditis. He previously had an operation for ventriculer septal defect (perimembranous type) about 9 years ago . An echocardiogram showed a large vegetation on the anterior cusp area and a left to right shunt through VSD, which was previously closed with dacron patch. A valve replacement in addition to antibiotic therapy was recommended for the patient. The patient underwent on operation : tricuspid valve replacement was done with 51. Jude medical valve prosthesis (33 mm), and in addition to above procedure, removal of vegetation and direct closure of VSD were done Postoperative echocardiogram showed that replaced tricuspid valve functioned well and vegeta ion and shunt flow were not observed. The patient recovered without complication and discharged at Postoperative day 25. Early aggressive surgical intervention is indicated to optimize surgical results, and this case seems to be a typical right sided bacterial endocarditis, which is caused by residual VSD. We are reporting a case of tricuspid valve endocarditis with a review of the literature. (Korean J Thorax Cardiovasc Surg 1996 ; 29: 440-3)
Journal of the Korean Academy of Child and Adolescent Psychiatry
/
v.18
no.2
/
pp.117-122
/
2007
Practice parameters for non-pharmacological treatment of children and adolescents with pervasive developmental disorders are based on the scientific literature for evidence-based practices. Appropriate educational and behavioral interventions are important in improving the long-term outcome in pervasive developmental disorders. Early and sustained intervention appears to be particularly important. The goal for interventions is to gain pragmatic skills for verbal communication, playing with peers, daily living routines, self-management, and social adaptation. Appropriate involvement and collaboration with parents and family are essential for well-functioning intervention programs. The life-long nature of autism implies that the clinician should maintain an active role in long-term treatment planning and family support. Vocational training and training for more independent living are important for adolescents with autism. Professionals should be knowledgeable about local and national resources and opportunities for family support as well as support of the individual.
Purpose: This study was done to identify the influence of severity of drinking problem, circadian rhythm and sleep quality in patients with alcohol use. Methods: A descriptive study design was utilized. Data were collected using self-report questionnaires from 139 patients with alcohol use disorder who were admitted to a psychiatric hospital in D city, Korea. The questionnaires included Alcohol Use Disorders Identification Test (AUDIT), Composite Scale of Morningness (CMS), Pittsburgh Sleep Quality Index (PSQI), and Korea sleep scale A. Data were analyzed using descriptive statistics, Pearson's correlation coefficients, and multiple regressions using the SPSS 20.0 program. Results: There was significant correlations among severity of problem drinking, circadian rhythm, sleep quality and sleep disorder. The significant factors influencing sleep disorder were severity of problem drinking(${\beta}=.12$, p= .042), circadian rhythm(${\beta}=-.14$, p= .039) and sleep quality(${\beta}=.63$, p= < .001). This model explained 56% of variance in sleep disorder(F = 57.34, p= < .001). Conclusion: The results of this study suggest that the development of sleep intervention programs for alcohol use disorder patients needs to consider severity of alcohol use, circadian rhythm and sleep quality, and sleep assessment and intervention are needed the early stage of the treatment and recovery process.
Allergic Rhinitis (AR) is an IgE (immunoglobin-E) mediated inflammatory condition of upper respiratory tract; main clinical features involve runny nose, sneezing, nasal obstruction, itching and watery eyes. AR is a global problem and has large variations in incidences, currently affects up to 20% - 40% of the population worldwide. It may not be a life-threatening disease per se but indisposition from the condition can be severe and has the potential to adversely affect the daily functioning of life. Classical yoga literature indicates that, components of yoga have been used to treat numerous inflammatory conditions including upper respiratory tract. A few yoga intervention studies reported improvement in lung capacity, Nasal air flow and symptoms of allergic rhinitis. This review examined various anti-inflammatory pathways mediated through Yoga that include downregulation of pro-inflammatory cytokines and upregulation of anti-inflammatory cytokines. The hypothalaminic-pitutary-adrenal (HPA) axis and vagal efferent stimulation has been reported to mediate anti-inflammatory effect. A significant reduction is also reported in other inflammatory biomarkers like- TNF-alpha, nuclear factor kappa B (NF-κB), plasma CRP and Cortisol level. Neti, a yogic nasal cleansing technique, reported beneficial effect on AR by direct physical cleansing of thick mucus, allergens, and inflammatory mediator from nasal mucosa resulting in improved ciliary beat frequency. We do not find any study showing effect of yoga on neurogenic inflammation. In summary, Integrated Yoga Therapy may have beneficial effect in reducing symptoms and improving quality of life for patients with allergic rhinitis. Yoga may reduce inflammation through mediating neuro-endocrino-immunological network. Future studies are needed to explore the mechanism how yoga might modulate immune inflammation cascade and neurogenic inflammation at the cellular level in relevance to allergic rhinitis; the effects of kriyas (yogic cleansing techniques) also need to be evaluated in early and late phase of AR. So the proposed model could guide future research.
Background Xeroderma pigmentosum (XP) is an autosomal recessive disorder characterized by xerosis, ultraviolet light sensitivity, and cutaneous dyspigmentation. Due to defects in their DNA repair mechanism, genetic mutations and carcinogenesis inevitably occurs in almost all patients. In these patients, reconstruction of cutaneous malignancies in the head and neck area is associated with some challenges such as likelihood of recurrence and an aggressive clinical course. The aim of this study is to discuss the therapeutic options and challenges commonly seen during the course of treatment. Methods Between 2005 and 2015, 11 XP patients with head and neck cutaneous malignancies were included in this study. Demographic data and treatment options of the patients were evaluated. Results The mean age of the patients was 32 years (range, 10-43) (4 males, 7 females). The most common tumor type and location were squamous cell carcinoma (6 patients) and the orbital region (4 patients), respectively. Free tissue transfer was the most commonly performed surgical intervention (4 patients). The average number of surgical procedures was 5.5 (range, 1-25). Six patients were siblings with each other, 5 patients had local recurrences, and one patient was lost to follow-up. Conclusions Although genetic components of the disease have been elucidated, there is no definitive treatment algorithm. Early surgical intervention and close follow-up are the gold standard modalities due to the tendency toward rapid tumor growth and possible recurrence. Treatment must be individualized for each patient. In addition, the psychological aspect of the disease is an important issue for both patients and families.
Between January 1986 and June 1994, 23 patients underwent surgical intervention for infective endocarditis at Wonkwang University Hospital. There were 13 male and 5 female, ran ing in age from 13 to 67(mean 43.7 $\pm$ 5.8) years. 21 had native valve endocarditis and 2 had prosthetic valve endocardits. The most common causative organism was streptococci in 9 patients, and the others were staphylococci in 7 patients and unknown in 7 patients. The infection was in the mitral valve in 10 patients, the aortic valve in 6 patients, the aortic and mitral In 5 patients, 2 in tricuspid. Surgical indications for surgery were intractable congestive heart failure, giant growing vegetation and severe valvular insufficiency. There were 3 perioperative death (13%) and no late death. The main causes of death were cerebral embolism in 2 due to recurrent endocarditis and low cardiac output in 1. By NYHA functional classification, all patients were in class III or IV preoperatively, and all patients were improved postoperatively with HYHA functional classification in class I or II. In conclussion, early operative intervention is life-salving in patients with persistent or progres ive congestive heart failure, irrespective of the activity of the infectious process or the duration of antibiotic therapy.
AIDS and the spectrum of Human Immunodeficiency Virus(HIV) infections present a monumental challenge to the health of the Korean public. In response to this special challenge, I think public education and voluntary behavior changes are the most effective measures to fight the spread of the disease. Adolescents represent a critical risk group for prevention and intervention programming. Research indicates sexually active adolescents, homosexual contact, illicit drug use are an gradually increasing. These characteristically adolescent risk-taking behaviors suggest the need for schools and communities to mobilize intervention strategies. Schools are highly efficient ways to reach a majority of young people in Korea with HIV prevention programs. These programs include substantial attention to sexual and drug use behaviors with the long term objective of a multidimensional school health program. Information resulting from risk behavior surveillance activities and guidance on school health curricula is particularly useful. What is needed for adolescents is a revamping of education to give students the critical thinking and analytic skills that allow them to apply knowledge, make decisions, and think independently. The best HIV preventive education provides young people with opportunities to learn and practice just those skills. In the early stages of HIV education were focused solely on information. Providing information is easy but unfortunately, behavior change is not that simple to activate. Information must be combined with values exploration and skilly building, including responsible decision making, negotiation, refusal, and critical thinking skills. The same knowledge, attitudes and skills needed for effective HIV prevention also prevent or reduce other risks, including other sexually transmitted diseases, unwanted pregnancies, and alcohol or other drug use. The role of other youth serving organizations in HIV prevention is also important: parental and youth involvement is needed; it's important to presidential and governament leadership is essential to prevention education; promote integrated adolescent programs, to enhance health and education sector collaboration; and of course, we need to expand research on adolescent health and engage the media in health promotion. Among these changes, a school-based systematic health education of AIDS is certainly one of the essentials.
The purpose of this study was to use as a basic data to develop suitable nursing intervention program and decide an appropriate intervention time after assessing shoulder range of motion in postmastectomy from 2 weeks to 3 month. 147 patients are chosen as study subject among patients who were in recovery of 2weeks, 1month, 2months and 3 months after surgical operation which is modified radical mastectomy. Data were collected at oncology medicine local and general surgery local in Seoul National University Hospital from May, 2003 to October, 2003. The range of motion of the shoulder(flexion, extension, abduction, internal rotation, external rotation) were examined. Analysis of data that shoulder range of motion average and standard deviation, percentage of the unaffected side and affected side compare with normal shoulder range of motion. Paired t-test was adopted to analyze the difference between affected side and unaffected side. Conclusion from this study is as following, 1. The most serious problem was external rotation (0.56%) and internal rotation is the next (19.9%) in 5 kinds of shoulder range of motion in 2 weeks after surgical operation 2. There was no difference in internal rotation after post operation 3 months but there were differences and shown to recover more than 90% in flexion and abduction. Also shoulder function incresed in flextion less than 80% and more than 80% in external rotation. As this study finding was shown that shoulder range of motion did not get back perfectly except of internal rotation and extension in point of 3 months after breast cancer surgical operation. External rotation was specially shown the lowest result so it is needed to exercise for improving their physical functioning recovery in postmastectomy patients. And it is suggested to study for helping to postmastectomy patients' physical and psycosocial functions with the early rehabilitation program which is based on these results.
Purpose: This study was conducted to investigate relationship between delirium, risk factors on delirium, and patient prognosis based on Donabedian's structure-process-outcome model. Methods: This study utilized a path analysis design. We extracted data from the electronic medical records containing delirium screening data. Each five hundred data in a delirium and a non-delirium group were randomly selected from electronic medical records of medical and surgical intensive care patients. Data were analyzed using SPSS 20 and AMOS 24. Results: In the final model, admission via emergency department (Β=.06, p=.019), age over 65 years (Β=.11, p=.001), unconsciousness (Β=.18, p=.001), dependent activities (Β=.12, p=.001), abnormal vital signs (Β=.12, p=.001), pressure ulcer risk (Β=.12, p=.001), enteral nutrition (Β=.12, p=.001), and use of restraint (Β=.30, p=.001) directly affecting delirium accounted for 56.0% of delirium cases. Delirium had a direct effect on hospital mortality (Β=.06, p=.038), hospital length of stay (Β=5.06, p=.010), and discharge to another facility (not home) (Β=.12, p=.001), also risk factors on delirium indirectly affected patient prognosis through delirium. Conclusion: The use of interventions to reduce delirium may improve patient prognosis. To improve the dependency activities and risk of pressure ulcers that directly affect delirium, early ambulation is encouraged, and treatment and nursing interventions to remove the ventilator and drainage tube quickly must be provided to minimize the application of restraint. Further, delirium can be prevented and patient prognosis improved through continuous intervention to stimulate cognitive awareness and monitoring of the onset of delirium. This study also discussed the effects of delirium intervention on the prognosis of patients with delirium and future research in this area.
The purpose of this study was using a meta-analysis to estimate effect size of emotional intelligence program. Using a statistical method, meta-analysis has advantages that prove intervention's amount and direction. Meta-analysis facilitates comprehensive analysis. Through the data collection, 33studies were selected and 92 effect size were calculated as analysis objects. The overall effect size of emotional intelligence program was 0.839. Depend on subordinate scope, the emotional cognition had the largest effect size. Next were the understanding domain, application domain, the regulation domain and the expression domain. Analysis on age of participant, adult group had the largest effect size. Next were the elementary students group and the adolescent group. Based on the findings, implications for future study were discussed.
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