Papillary Histiocytic and Mesothelial Hyperplasia of the Ovary Related to a Huge Uterus: A Case Report

Nodular histiocytic/mesothelial hyperplasia (NHMH) is a very rare condition. It is generally thought to be associated with repeated mechanical or chemical stimulation. This study reported NHMH with papillary growth pattern in the ovary following high-intensity focused ultrasound (HIFU) treatment for uterine leiomyoma and adenomyosis. A 48-year-old female, who had a history of undergoing HIFU treatment 7 times for adenomyosis and leiomyoma of the uterus 6 months ago, was referred to the hospital. After the hysterectomy and right salpingo-oophorectomy, the patient was confirmedly diagnosed with nodular histiocytic and mesothelial hyperplasia with the papillary growth pattern of the right ovary. This benign reactive inflammatory lesion of the mesothelium mimicking malignancy must be kept in mind to avoid unnecessary treatment.

Comparison of work stress, depression, insomnia, and fatigue of emergency department medical staff according to the emergency medical institutions and general characteristics during COVID-19 epidemic

Objective@#The objective of this study was to investigate job stress, depression, insomnia, and fatigue of coronavirus disease 2019 (COVID-19) medical staff and analyze the differences according to their general characteristics. @*Methods@#The study enrolled 98 workers at emergency medical institutions with COVID-19 treatment facilities located in Gangwon Province. An online survey was used to protect personal information. Data were analyzed using the statistical program SPSS version 28. The differences in job stress, depression, insomnia, and fatigue of COVID-19 medical staff were verified by t-test and analysis of variance. @*Results@#Analyzing job stress revealed that the average of the lowest relationship conflict stress for each sub-factor was 2.22, the average stress for job demand was the highest at 3.78, and the average whole job stress was 3.04. Contrarily, the average for depression was 1.69, insomnia 2.96, and fatigue 3.07. No statistically significant differences were observed for job stress, depression, insomnia, and fatigue when considering the type of workplace, gender, and occupation of COVID-19 medical staff. However, statistically significant differences were obtained in some variables including age, family members, working period, COVID-19 confirmed, and COVID-19-related education experience. @*Conclusion@#In this study, differences in job-related stress, depression, insomnia, and fatigue were confirmed considering the general characteristics of COVID-19 medical staff. In particular, the results of this study are significant since the difference in perceived stress in performing COVID-19 tasks was identified through empirical analysis by considering sub-factors of job stress.

Preseptal upper eyelid lipoma: a case report

Lipomas are benign soft-tissue tumors that typically progress gradually. In this case report, we describe a 77-year-old woman who presented with a mass on the left upper eyelid. An ophthalmologic examination was normal, and ultrasonography revealed a 1-cm ill-defined mass in the subcutaneous fat layer of the left upper eyelid. The tumor was completely excised surgically, and a histopathological examination showed mature fibro-adipose tissue consistent with a lipoma. The patient had an excellent postoperative prognosis. Even though eyelid lipomas are extremely rare, it is important to carefully examine the integrity of the orbital muscle, orbital septum, and levator aponeurosis. Lipoma should be distinguished from herniated orbital fat or the lacrimal glands in the differential diagnosis of an upper eyelid mass.

Multilocular Cystic Renal Neoplasm of Low Malignant Potential: A Case Report and Literature Review

Multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) is a rare subtype of renal cell carcinoma that has a favorable outcome. Most cases of MCRNLMP usually present as distinct multilocular cystic lesions; however, they may appear as small complicated cysts with hemorrhagic components. Herein, we present a case of MCRNLMP and provide a review of the literature.

Development and Validation of Simple Age-Adjusted Objectified Korean Triage and Acuity Scale for Adult Patients Visiting the Emergency Department

Purpose@#The study aimed to develop an objectified Korean Triage and Acuity Scale (OTAS) that can objectively and quickly classify severity, as well as a simple age-adjusted OTAS (S-OTAS) that reflects age and evaluate its usefulness. @*Materials and Methods@#A retrospective analysis was performed of all adult patients who had visited the emergency department at three teaching hospitals. Sex, systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, body temperature, O 2 saturation, and consciousness level were collected from medical records. The OTAS was developed with objective criterion and minimal OTAS level, and S-OTAS was developed by adding the age variable. For usefulness evaluation, the 30-day mortality, the rates of computed tomography scan and emergency procedures were compared between Korean Triage and Acuity Scale (KTAS) and OTAS. @*Results@#A total of 44402 patients were analyzed. For 30-day mortality, S-OTAS showed a higher area under the curve (AUC) compared to KTAS (0.751 vs. 0.812 for KTAS and S-OTAS, respectively, p<0.001). Regarding the rates of emergency procedures, AUC was significantly higher in S-OTAS, compared to KTAS (0.807 vs. 0.830, for KTAS and S-OTAS, respectively, p=0.013). @*Conclusion@#S-OTAS showed comparative usefulness for adult patients visiting the emergency department as a triage tool compared to KTAS.

Risk Factors for Renal Function Impairment Following Radiofrequency Ablation of Renal Tumors

Purpose@#To evaluate the various factors that affect renal function following percutaneous radiofrequency ablation (RFA) therapy in patients with renal tumors. @*Materials and Methods@#Between 2010 and 2018, 91 patients diagnosed with renal tumors using ultrasonography and CT-guided RFA were enrolled. We retrospectively investigated the serum creatinine (SCr) level and estimated glomerular filtration rates immediately prior to RFA and during post-treatment follow-up. The patients were divided into two groups based on the degree of change in SCr level (0.3 mg/dL). Group comparisons were performed using univariable and multivariable logistic regression analyses to determine the factors impacting renal function. @*Results@#Impaired renal function was associated with solitary kidney, chronic kidney disease (CKD) over stage 3, and pyeloureteral injury. Sex, age, other cancers, tumor size, location, growth pattern, and proximity to the collecting system were not significantly associated with impaired renal function. There was a difference in the overall change over time between the association with and without solitary kidney, CKD stage 3, and pyeloureteral injury. @*Conclusion@#Among the medical conditions present prior to RFA, solitary kidney and CKD over stage 3 could be considered as risk factors for impaired renal function. Post-procedural pyeloureteral injury can also be considered a risk factor.

Factors affecting mortality and complications of elderly patients with hip fracture

Objective@#The incidence of hip fractures in South Korea is increasing, and it is also a socioeconomic burden. This study analyzed the factors affecting the mortality and complications of hip fracture patients. @*Methods@#The Korean National Hospital Discharge In-depth Injury Survey was used to investigate the sex, age, Charlson comorbidity index (CCI), insurance type, pre-operation length of hospital stay, fracture type, operation type, and the number of beds in the hospital from 2009 to 2018. @*Results@#A total of 3,898 patients were enrolled. There were statistical differences in sex, age, insurance type, and CCI divided into the survival and the non-survival groups. There were statistical differences in age, CCI, and the number of beds divided into the group without complications and the group with complications. Multivariate logistic regression analysis revealed that men, age > 84 years (odds ratio [OR], 3.064; 95% confidence interval [CI], 2.000-4.692), medical aid (OR, 2.724; 95% CI, 1.672-4.436), and CCI≥3 (OR, 3.968; 95% CI, 2.555-6.162) were risk factors for the mortality and also revealed that age > 84 years (OR, 3.195; 95% CI, 2.18-4.683) and CCI≥3 (OR, 5.773; 95% CI, 4.174-7.986) were risk factors for the complications. @*Conclusion@#In this study, the factors affecting the mortality were men, old age, medical aid, and underlying diseases, and the factors affecting complications were old age and underlying diseases.

Urothelial Carcinoma of the Bladder: Radiologic Perspective

Bladder cancer is a relatively common cancer type, with a high recurrence rate, that can be often encountered in the imaging study. Accurate diagnosis and staging have a significant impact on determining treatment and evaluating prognosis. Bladder cancer has been evaluated by transurethral resection of bladder tumor for clinical staging and treatment, but it is often understaged when compared with final pathologic result by radical cystectomy. If the location, size, presence of muscle invasion, lymph node metastasis, distant metastasis, and presence of upper urinary tract cancer can be accurately diagnosed and evaluated in an imaging study, it can be treated and managed more appropriately. For an accurate diagnosis, radiologists who evaluate the images must be aware of the characteristics of bladder cancer as well as its types, imaging techniques, and limitations of imaging studies. Recent developments in MRI with functional imaging have improved the quality of bladder imaging and the evaluation of cancer. In addition, the Vesical Imaging Reporting and Data System was published to objectively assess the possibility for muscle invasion of cancer. Radiologists need to know the types of bladder cancer treatment and how to evaluate the changes after treatment. In this article, the characteristics of bladder urothelial carcinoma, various imaging studies, and findings are reviewed.

Early and Atypical Radiologic Presentations of Pulmonary Langerhans Cell Histiocytosis:A Report of Two Cases

Pulmonary Langerhans cell histiocytosis (PLCH) is a rare, multi-systemic disease primarily affecting young male adults with a history of smoking. The two patients with PLCH in our report showed relatively early and atypical radiologic presentations at initial evaluation. On chest CT, PLCH presents variable radiologic features depending on the evolutional stage of the disease. Atypical CT features of PLCH may render precise radiologic diagnosis difficult and usually require lung biopsy for a confirmation of the diagnosis. Our case review is aimed at raising the awareness of radiologists on the atypical CT features of PLCH, to help make accurate radiologic diagnosis and prevent unnecessary and invasive diagnostic procedures.

The incidence and characteristics of patients admitted to the hospital after a fall by the life cycle and risk factor for death

Objective@#This study aimed at identifying the incidence rate and characteristics of patients who had suffered falls, classifying them by life cycle and factors that affect mortality. @*Methods@#The Korean National Hospital Discharge In-depth Injury Surveys (KNHDIS) from 2007 to 2016 were used to investigate the sex, age, place, season, payment method, underlying disease, and the death of hospitalized patients due to falls. @*Results@#The number of hospitalized patients increased with age. In all life cycles except old age, men were hospitalized more than women. The payment method for treatment was 66.1% through national health insurance, 6.6% through medical aid, and 27.3% through other sources. Falls were most common in winter and occurred frequently at home and on the road. In terms of the number of patients, the compound annual growth rate was 0.9% for men and 3.7% for women. In terms of the number of deaths in hospitals, the compound annual growth rate was -1.9% for men and -7.2% for women. Mortality risk was high in men in middle adulthood and old age, in patients with underlying diseases, and in patients who suffered a fall in their homes. @*Conclusion@#The number of patients from falls is increasing, but the deaths of hospitalized fall patients are decreasing. Mortality risk was high in men in middle adulthood and old age, in patients with underlying diseases, and in patients who suffered falls in their homes.

Urothelial Carcinoma of the Bladder: Radiologic Perspective

Bladder cancer is a relatively common cancer type, with a high recurrence rate, that can be often encountered in the imaging study. Accurate diagnosis and staging have a significant impact on determining treatment and evaluating prognosis. Bladder cancer has been evaluated by transurethral resection of bladder tumor for clinical staging and treatment, but it is often understaged when compared with final pathologic result by radical cystectomy. If the location, size, presence of muscle invasion, lymph node metastasis, distant metastasis, and presence of upper urinary tract cancer can be accurately diagnosed and evaluated in an imaging study, it can be treated and managed more appropriately. For an accurate diagnosis, radiologists who evaluate the images must be aware of the characteristics of bladder cancer as well as its types, imaging techniques, and limitations of imaging studies. Recent developments in MRI with functional imaging have improved the quality of bladder imaging and the evaluation of cancer. In addition, the Vesical Imaging Reporting and Data System was published to objectively assess the possibility for muscle invasion of cancer. Radiologists need to know the types of bladder cancer treatment and how to evaluate the changes after treatment. In this article, the characteristics of bladder urothelial carcinoma, various imaging studies, and findings are reviewed.

Early and Atypical Radiologic Presentations of Pulmonary Langerhans Cell Histiocytosis:A Report of Two Cases

Pulmonary Langerhans cell histiocytosis (PLCH) is a rare, multi-systemic disease primarily affecting young male adults with a history of smoking. The two patients with PLCH in our report showed relatively early and atypical radiologic presentations at initial evaluation. On chest CT, PLCH presents variable radiologic features depending on the evolutional stage of the disease. Atypical CT features of PLCH may render precise radiologic diagnosis difficult and usually require lung biopsy for a confirmation of the diagnosis. Our case review is aimed at raising the awareness of radiologists on the atypical CT features of PLCH, to help make accurate radiologic diagnosis and prevent unnecessary and invasive diagnostic procedures.

The incidence and characteristics of patients admitted to the hospital after a fall by the life cycle and risk factor for death

Objective@#This study aimed at identifying the incidence rate and characteristics of patients who had suffered falls, classifying them by life cycle and factors that affect mortality. @*Methods@#The Korean National Hospital Discharge In-depth Injury Surveys (KNHDIS) from 2007 to 2016 were used to investigate the sex, age, place, season, payment method, underlying disease, and the death of hospitalized patients due to falls. @*Results@#The number of hospitalized patients increased with age. In all life cycles except old age, men were hospitalized more than women. The payment method for treatment was 66.1% through national health insurance, 6.6% through medical aid, and 27.3% through other sources. Falls were most common in winter and occurred frequently at home and on the road. In terms of the number of patients, the compound annual growth rate was 0.9% for men and 3.7% for women. In terms of the number of deaths in hospitals, the compound annual growth rate was -1.9% for men and -7.2% for women. Mortality risk was high in men in middle adulthood and old age, in patients with underlying diseases, and in patients who suffered a fall in their homes. @*Conclusion@#The number of patients from falls is increasing, but the deaths of hospitalized fall patients are decreasing. Mortality risk was high in men in middle adulthood and old age, in patients with underlying diseases, and in patients who suffered falls in their homes.

Outcome of cardiopulmonary resuscitation for prehospital traumaticcardiac arrest: focused on Gangwon province

Objective@#This aim examined the outcomes of resuscitation and the clinical characteristics of patients with pre-hospitaltraumatic cardiac arrests (TCA). @*Methods@#The charts of patients with pre-hospital TCA who visited the various emergency department (ED) in Gangwondofrom January 2013 to December 2017 were reviewed retrospectively. @*Results@#TCA patients comprised 0.3% of patients transferred by 119. A total of 367 patients were enrolled in the study.Traffic accidents were the leading cause of the arrest. The initial field and ED rhythm were mostly asystole (field, 79.6%;ED, 82.3%). It took 11.24±9.95 minutes from the call to the field. From the field to ED, it took 22.87±15.37 minutes. Thetotal CPR time before ED arrival was 21.62±15.29 minutes. The causes of TCA were brain injury (35.7%), hypovolemicshock (29.2%), and severe lung injury (16.3%). Seventy TCA patients experienced at least one return of spontaneous circulation(ROSC). Twenty-six patients (7.14%) were admitted to the ward, and their average injury severity score was38.96. Eight patients expired before 12 hours after transient ROSC. Four more patients expired before 24 hours. Fourpatients were discharged alive among patients who lived for more than 24 hours. @*Conclusion@#In this study, 1.5% of patients were discharged alive. The possibility of ROSC was higher as the time to ED,and the cardiopulmonary resuscitation time of 119 was shorter. Pulseless electrical activity rather than asystole tends topromote ROSC. The survival rate increased when ROSC occurred before arriving at the ED.

Missed Lung Cancers on Chest Radiograph: An Illustrative Review of Common Blind Spots on Chest Radiograph with Emphasis on Various Radiologic Presentations of Lung Cancers

Missed lung cancers on chest radiograph (CXR) may delay the diagnosis and affect the prognosis. CXR is the primary imaging modality to evaluate the lungs and mediastinum in daily practice. The purpose of this article is to review chest radiographs for common blind spots and highlight the importance of various radiologic presentations in primary lung cancer to avoid significant diagnostic errors on CXR.

Missed Lung Cancers on Chest Radiograph: An Illustrative Review of Common Blind Spots on Chest Radiograph with Emphasis on Various Radiologic Presentations of Lung Cancers

Missed lung cancers on chest radiograph (CXR) may delay the diagnosis and affect the prognosis. CXR is the primary imaging modality to evaluate the lungs and mediastinum in daily practice. The purpose of this article is to review chest radiographs for common blind spots and highlight the importance of various radiologic presentations in primary lung cancer to avoid significant diagnostic errors on CXR.

Incidental Solid Renal Masses: Radiologic Assessment and Managements

The steady increase in imaging studies has led to the incidental discovery of many renal masses. Although most incidental solid renal masses are asymptomatic and small in size, they are mostly malignant renal cancers necessitating accurate diagnosis. Small-sized masses are more likely to be benign tumors; therefore, access is needed according to size. Because most malignant tumors are renal cell carcinoma, and most benign tumors are angiomyolipoma and oncocytoma. Knowledge of common imaging findings of these tumors is helpful for diagnosis and management. However, imaging techniques are often insufficient to characterize solid renal masses which are discovered incidentally in radiological examinations, especially small-sized masses. Herein, we describe the imaging features characteristic of incidental solid renal masses and discuss their management in cases when an accurate diagnosis could or could not be made.

Victim-oriented digital disaster emergency medical system

The fatality rate of a disaster is associated with the impact of the disaster and the case fatality rate. The severity of the disaster can be reduced by an efficient disaster management system, and the capacity of the trained disaster response system can lower the case mortality rate. The severity of a disaster is determined by the interaction of risk factors and vulnerabilities in a particular area, and the case-fatality rate is determined by a correlation between the capacity of the disaster response team and the survivability of the victims. The disaster management system and the disaster response system are complementary and interconnected, and the efficiency of cooperation and linkage can be improved by developing well organized digitalization. Efforts to increase the survival rate of victims through digitalization has been a continued process and new alternatives are being developed in accordance with the advances in information and communication technology to manage disaster risk factors and to improve disaster response capabilities. However, in case of mass casualty incidents, it is still difficult to reduce the case mortality rate by securing the survival time limit of the victims. Often, sharing the disaster scene information and communicating with the victim is not feasible. A lack of ability to provide real time escape route to exit or safe zone proves fatal. The communication revolution of the next generation wireless wide area network called 5G can overcome the disruption of communication network during the disaster incidents. It can enable real time tracking of the position of victim and linking the victims with its rescuers. Hence, it is possible to increase the survival rate of victims during mass casualty incidents by associating information and communication technologies with appropriate disaster management and response strategies, real-time information exchange and education and training of rescuers and citizens.

Clinical characteristics of intentional self-harm inpatient with lethal methods

OBJECTIVE: The aim of this study was to identify the latent class, according to the risk factors, of the patients hospitalized due to intentional self-harm by lethal means. METHODS: The risk factors were derived by categorizing the intentional self-harming measures by lethal (hanging, pesticide poisoning, jumping, and drowning) and non-lethal (drug poisoning and stab) measures and comparing the demographics, diseased state, and suicide-related characteristics. Latent class analysis was performed to identify the type of intentional self-harm. RESULTS: Male (sex), elderly (age), rural (residing location), and comorbid diseases were found to be the risk factors for fatal injuries. For this, four latent classes were modeled. Factors, such as the age group between 20 to 40 years, women, and family conflict were included in the first class. The second class included the age group between 30 to 50 years, men, and financial problems. The third class covered the age group between 60 to 70 years and comorbidity. The fourth class contained the age group of 10 to 50 years, women, and mental problems. The rate of suicide and choice of fatal suicide was ranked in the order of 3 (62.7%, 21.5%), 2 (59.8%, 13.9%), 4 (36.8%, 5.7%), and 1 (29.5%, 5.9%). CONCLUSION: A lethal mean access control policy needs to be established for the high-risk group of self-harm. Moreover, establishing an emergency room-community link prevention policy could help reduce the re-suicide attempt among suffering patients.

Victim-oriented digital disaster emergency medical system

The fatality rate of a disaster is associated with the impact of the disaster and the case fatality rate. The severity of the disaster can be reduced by an efficient disaster management system, and the capacity of the trained disaster response system can lower the case mortality rate. The severity of a disaster is determined by the interaction of risk factors and vulnerabilities in a particular area, and the case-fatality rate is determined by a correlation between the capacity of the disaster response team and the survivability of the victims. The disaster management system and the disaster response system are complementary and interconnected, and the efficiency of cooperation and linkage can be improved by developing well organized digitalization. Efforts to increase the survival rate of victims through digitalization has been a continued process and new alternatives are being developed in accordance with the advances in information and communication technology to manage disaster risk factors and to improve disaster response capabilities. However, in case of mass casualty incidents, it is still difficult to reduce the case mortality rate by securing the survival time limit of the victims. Often, sharing the disaster scene information and communicating with the victim is not feasible. A lack of ability to provide real time escape route to exit or safe zone proves fatal. The communication revolution of the next generation wireless wide area network called 5G can overcome the disruption of communication network during the disaster incidents. It can enable real time tracking of the position of victim and linking the victims with its rescuers. Hence, it is possible to increase the survival rate of victims during mass casualty incidents by associating information and communication technologies with appropriate disaster management and response strategies, real-time information exchange and education and training of rescuers and citizens.