The Relation between Care Worker’s Empathic Response and Specificity of Autobiographic Memory in Health Elderly Living Alone

Objective@#This study aimed to investigate relation between empathic response of care workers and specificity of autobio-graphic memory of the elderly living alone. @*Methods@#An interview of autobiographical memory was conducted on 66 physically and mentally healthy elderly people living alone in the community. The transcript was used to evaluate the empathic responses of the care workers and to classify thespecificity of the autobiographical memory into four categories: episodic, categoric, semantic, and error. Logistic regression was used for investigation relation between empathic response of care workers and specificity of autobiographic memory of the elder-ly living alone. @*Results@#More than half of the elderly reported specific autobiographical memories, and the interviewers showed a high level of empathic response when the elderly reported specific memories. Episodic and categoric autobiographical memory had a high empathic response of interviewer, and semantic memory or error type memory had a low empathic response. Empathy enhance-ment program experience showed not significantly association with empathic response of interviewer. @*Conclusion@#Further research is needed on interview techniques that can easily and conveniently talk about specific autobio-graphical memories.

Analysis of the Proportion of Patients Who Were Admitted to the Emergency Department of the Tertiary Care Hospital for Primary Care

BACKGROUND: The medical service delivery system in Korea works inefficiently and patients tend to visit tertiary hospitals by means of the emergency department (ED). Overcrowding of the ED threatens the health and life of emergency patients as a result of the inability to effectively distribute emergency medical resources in the community. To solve this problem, improvement in the medical delivery system and dispersion of patients by strengthening primary care may be helpful. In order to make policy decisions for this, it is necessary to estimate the scale of patients who can be distributed to primary care.METHODS: From January 1 to December 31, 2016, we analyzed the National Emergency Department Information System (NEDIS) data of patients who visited a tertiary ED to examine the proportion of patients eligible for primary medical care. The inclusion and exclusion criteria for primary care were made through the consensus of three physicians.RESULTS: A total of 65,061 NEDIS records were analyzed. Among them, by inclusion criteria, 29,818 cases were Korean Triage and Acuity Scale level 4 and 5, and 11,791 patients visited the ED during the day. After considering the exclusion criteria, there were 6,468 cases who may be suitable for primary medical care.CONCLUSION: Of the patients who visited the ED of tertiary hospitals, approximately 10% of them may be suitable for primary care. There should be a discussion and social consensus to reduce overcrowding in EDs and deliver better medical services.

The Characteristics of Terminally Ill Cancer Patients in Hospice and Palliative Care according to Family Composition / 한국호스피스완화의료학회지

PURPOSE: The purpose of this study was to investigate the family composition of terminally ill cancer patients admitted to the hospice unit and how it affects their hospice care. METHODS: We retrospectively analyzed the medical records of terminal cancer patients who died in one hospice unit between January 2009 and March 2014. The demographic and clinical characteristics of the patients were examined, and any different made by their marital status was evaluated. We calculated the time interval between cancer diagnosis and hospice admission and the survival period from hospice admission to death and analyzed their association with family composition. RESULTS: When divided by the median time of 13 months between diagnosis and admission, Group B (>13 months) had a significantly higher proportion of patients living with their spouses; (P < 0.01). The main decision maker was a spouse (52.9%) in Group B; (P=0.04). CONCLUSION: Among the characteristics of the family composition, the presence of spouse was an important factor associated with admission to a hospice unit. Clinicians need to be aware of the impact of marital status on end-of-life care. This study indicates that it is helpful to understand family composition of terminally-ill cancer patients for an effective palliative and hospice care.

Recovery without Neurological Sequelae in Fulminant Cerebral Edema in Pediatric Encephalitis with Human Herpesvirus Type 6 / 대한소아신경학회지

Viral encephalitis can lead to serious neurological sequelae and death among younger children. It is also known that the mortality rate in encephalitis with cerebral edema or transtentorial brain herniation is higher. A 4-year-old boy visited our emergency department exhibiting mental change. The patient had a high fever for four and a whole-body rash for three days prior to his visit. He had displayed irritable symptoms and been vomiting for six hours before his visit, accompanied by seizure. After 13 hours of admission, the patient's right pupil became fixed and fully dilated, and the left pupil also became fixed and fully dilated within 30 minutes. Brain computed tomography (CT) was performed immediately, and severe brain swelling with transtentorial brain herniation was found. The mannitol dose was increased and dexamethasone was also added. Hyperventilation was performed through intubation to reach PaCO₂ levels of 25 to 30mmHg. Fifteen hours later, pupillary reflex was observed and the cerebral edema and transtentorial brain herniation was found to be improving in follow-up brain CT. He was transferred to a general ward after 11 days and discharged on the thirteenth hospital day without any neurological sequelae. Human herpesvirus type 6 (HHV-6) was detected in the serological polymerase chain reaction (PCR) examination.

Acute Myocardial Infarction with Cardiogenic Shock in a Young Adult with Minimal Change Disease / 대한내과학회지

Acute myocardial infarction (AMI) is very rare in young adults. Nephrotic syndrome is an uncommon cause of AMI in young adults and is characterized by excessive proteinuria, hypoalbuminemia, hyperlipidemia, and generalized edema. The hypercoagulable state and accelerated atherosclerosis in patients with nephrotic syndrome may be associated with the development of AMI in young adults. We report herein a case of ST-segment elevation myocardial infarction with sudden cardiac arrest in a young patient with minimal change disease.

Left Ventricular Strain as Predictor of Chronic Aortic Regurgitation

BACKGROUND: It is not well known about the implication of left ventricular (LV) strain as a predictor for mortality in patients with chronic aortic regurgitation (AR). The purpose of this study was to investigate whether global longitudinal strain measured by two-dimensional speckle-tracking echocardiography could predict long-term outcome in patients with chronic AR. METHODS: This is a single center non-randomized retrospective observational study. The patients with chronic AR from January 2002 to December 2012 were retrospectively enrolled. Following patients were excluded; combined other significant valvular disease, previous heart surgery, aortic disease, congenital heart disease, acute AR and young age under 18 years old. Finally, 60 patients were analyzed and the LV global strain rate was measured on apical four chamber image (GS-4CH). RESULTS: During 64 months follow-up duration, 16 patients (26.7%) were deceased and 38 patients (63.3%) underwent aortic valve replacement (AVR). Deceased group was older (69 years old vs. 51 years old, p < 0.001) and had lower longitudinal strain (-12.05 +/- 3.72% vs. -15.66 +/- 4.35%, p = 0.005). Kaplan-Meier survival curve stratified by GS-4CH showed a trend of different event rate (log rank p = 0.001). On multivariate analysis by cox proportional hazard model adjusting for age, sex, body surface area, history of atrial fibrillation, blood urea nitrogen, LV dilatation, LV ejection fraction and AVR, decreased GS-4CH proved to be an independent predictor of mortality in patients with chronic AR (hazard ratio 1.313, 95% confidence interval 1.010-1.706, p = 0.042). CONCLUSION: GS-4CH may be a useful predictor of mortality in patient with chronic AR.

A Case of Gastrointestinal Stromal Tumor of the Jejunum with Obscure Gastrointestinal Hemorrhage Diagnosed by Exploratory Laparotomy / 대한소화기내시경학회지

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract, and they represent about 2% of all neoplasms of the gastrointestinal tract. GISTs primarily affect the stomach (50~60%), but they can also affect the small intestine (20~30%), large intestine (7%) and esophagus (1%). The clinical manifestations of GISTs vary according to the location and size of the mass. GISTs are generally KIT (CD117)-positive and are diagnosed by immunohistochemistry. Tumor size and mitotic activity are the best predictive prognostic features. The treatment of choice for primary GIST is complete surgical resection with a negative margin. A 78-year-old man who presented with melena and diffuse abdominal pain was admitted to our hospital. Esophagogastroduodenoscopy, colonoscopy, angiography and an RBC scan were performed but we were unable to locate the focus of the hemorrhage. A gastrointestinal stromal tumor (GIST) of the jejunum was diagnosed after laparotomy.

A Case of Endogenous Endophthalmitis and Multifocal Pneumonia Complicated by Renal Abscess and Sepsis due to Escherichia coli / 대한신장학회지

Metastatic or septic endogenous endophthalmitis is a rare, but devastating complication of systemic septicemia. This condition may become more common as the number of chronically debilitated patients and the use of invasive procedures increase. Many etiologic organisms (gram-positive, gram-negative and fungi) and many clinical conditions (pyelonephritis, endocarditis, meningitis, pneumonia) have been reported to cause endogenous endophthalmitis. Risk factors include most of the known reasons for immune suppression and chronic illness. A high clinical suspicion is required in early diagnosis and treatment. Early antibiotics and vitrectomy are more widely accepted as therapeutic modalities.

Acute Pancreatitis and Septic Shock Complicated after Ureteroscopic Stone Removal in a Patient with Ureter Stones / 대한신장학회지

Being relatively safe, Ureteroscopy is one of the techniques most widely used for upper urinary tract diseases. Two cases of acute pancreatitis following percutaneous nephrolithotomy have been reported, but in neither case was there any complications after ureteroscopic procedure in patients with percutaneous nephrostomy. A 49-year-old male was presented with sudden onset of fever and decreased mental activity just after ureteroscopic stone removal. He had received nephrolithotomy for staghorn calculus six months before and received percutaneous nephrostomy 2 months before. Urine and blood cultures showed Citrobacter freundii and serum amylase and lipase increased to 6,067 IU/L, 1,270 IU/L, respectively. Abdominal CT scan demonstrated perinephric inflammatory fluid collection and its direct extension to the tail portion of pancreas. With medical treatment including adequate antibiotics, urosepsis and acute pancreatitis was completely cured.

Chinese Herbs Induced End-Stage Renal Disease in a Patient with Minimal Change Nephrotic Syndrome / 대한신장학회잡지

An outbreak of rapidly progressive renal failure was observed in Belgium in 1993 and was related to a slimming regimen involving Chinese herbs. Extensive interstitial fibrosis with atrophy and tubular loss was the major histological lesion. Aristolochic acid has been suspected to be responsible for nephrotoxicity. The use of Chinese herbal medicines is very popular in Korea. We report the presence of a nephrotoxic compound in herb medications, which led to end-stage renal failure in a patient with complete remission state of minimal change disease. The typical and sequential pathologic changes in our patient following the consumption of herbs suggest possible relationship to herbal medicines, and end-stage renal disease, despite the fact that a cause-and-effect relationship cannot be automatically inferred.

A Case of Patient with Coincident Lung Cancer and Rheumatoid Arthritis Treated with Docetaxel-Cisplatin Chemotherapy / 대한류마티스학회지

A 54-year-old male was admitted due to lung cancer and polyarthralgia involving wrist, hand, shoulder, and ankle joints. Five months ago, he had been diagnosed as adenocarcinoma of the lung, and treated with three cycles of chemotherapy using gemcitabine and cisplatin. In the course of chemotherapy, he had complained symmetrical polyarthralgia of hand and shoulder joints, resembling rheumatoid arthritis (RA). After treatment with chemotherapeutic agents, he still had severe polyarthritis refractory to anti-rheumatic drugs, including prednisolone, hydroxychloroquine, and methotrexate, and thus referred to our hospital. We changed the previous anti-cancer regimens to cisplatin plus docetaxel, a semisyntheic taxane molecule, which is known to suppress experimental polyarthritis. With additional three cycles of cisplatin plus docetaxel, RA disease activity as well as polyarthralgia was nearly completely resolved, and the extent of lung cancer was not aggravated. Although RA patients have an increased risk of malignancy, the outbreak of RA was very rare in lung cancer patients. Here we report a case of coincident lung cancer and rheumatoid arthritis, which was successfully treated by docetaxel plus cisplatin chemotherapy.

A Case of Pulmonary Endometriosis Treated by Resection / 결핵및호흡기질환

Periodic hemoptysis occurring at the time of menstruation (catamenial hemoptysis) is a rare disorder and generally signifies indicates the presence of thoracic endometriosis. A diagnosis of catamenial hemoptysis is usually established based on the clinical history and the exlusion of other causes of the recurrent hemoptysis. Serial computed tomograms of the chest during and in the interval between menstruations periods is a useful confirmatory test. We report the case of a 22 year-old women who suffered from catamenial hemoptysis for 10 months and was treated successfully with a wedge resection of the lesion by video-assisted thoracoscopic surgery(VATS). There was no evidence of recurrence. In conclusion. VATS is a good choice as a for single focus for catamenial hemoptysis.

A Case of Typhoid Fever Complicated with Massive Fatal Hemoptysis

We experienced a 25 year-old male patient with typhoid fever complicated with massive hemoptysis. Pulmonary complication in typhoid fever is very rare and to our knowledge, there has been no report of hemoptysis as a main cause of death with this disease. We herein report a rare case of typhoid fever.

A Case of Typhoid Fever Complicated with Massive Fatal Hemoptysis

We experienced a 25 year-old male patient with typhoid fever complicated with massive hemoptysis. Pulmonary complication in typhoid fever is very rare and to our knowledge, there has been no report of hemoptysis as a main cause of death with this disease. We herein report a rare case of typhoid fever.

Expression of c-erb A mRNA according to thyroid function status / 대한내분비학회지

No abstract available.