ABSTRACT
Background and Objectives@#Pathophysiological changes of right ventricle (RV) after repair of tetralogy of Fallot (TOF) are coupled with a highly compliant low-pressure pulmonary artery (PA) system. This study aimed to determine whether pulmonary vascular function was associated with RV parameters and exercise capacity, and its impact on RV remodeling after pulmonary valve replacement. @*Methods@#In a total of 48 patients over 18 years of age with repaired TOF, pulmonary arterial elastance (Ea), RV volume data, and RV-PA coupling ratio were calculated and analyzed in relation to exercise capacity. @*Results@#Patients with a low Ea showed a more severe pulmonary regurgitation volume index, greater RV end-diastolic volume index, and greater effective RV stroke volume (p=0.039, p=0.013, and p=0.011, respectively). Patients with a high Ea had lower exercise capacity than those with a low Ea (peak oxygen consumption [peak VO2 ] rate: 25.8±7.7 vs. 34.3±5.5 mL/kg/min, respectively, p=0.003), while peak VO2 was inversely correlated with Ea and mean PA pressure (p=0.004 and p=0.004, respectively). In the univariate analysis, a higher preoperative RV end-diastolic volume index and RV end-systolic volume index, left ventricular end-systolic volume index, and higher RV-PA coupling ratio were risk factors for suboptimal outcomes. Preoperative RV volume and RV-PA coupling ratio reflecting the adaptive PA system response are important factors in optimal postoperative results. @*Conclusions@#We found that PA vascular dysfunction, presenting as elevated Ea in TOF, may contribute to exercise intolerance. However, Ea was inversely correlated with pulmonary regurgitation (PR) severity, which may prevent PR, RV dilatation, and left ventricular dilatation in the absence of significant pulmonary stenosis.
ABSTRACT
We experienced a case of disseminated Staphylococcus aureus infection with bacterial pericarditis that progressed to septic shock and multiorgan failure despite pericardiocentesis and surgical removal of the original abscess with intensive antibiotic therapy. We report this case because of the patient’s very rare and remarkable echocardiographic findings and highly turbid pericardial effusion.
ABSTRACT
Objective@#To examine (1) the location of brain lesion that would predict post-traumatic delirium and (2) the association between volume of brain lesion and occurrence of delirium in patients with traumatic brain injury (TBI). @*Methods@#A retrospective study was conducted by reviewing medical records of 68 TBI patients, categorized into two groups: the delirious group (n=38) and non-delirious group (n=30). The location and volume of TBI were investigated with the 3D Slicer software. @*Results@#The TBI region in the delirious group mainly involved the frontal or temporal lobe (p=0.038). All 36 delirious patients had brain injury on the right side (p=0.046). The volume of hemorrhage in the delirious group was larger by about 95 mL compared to the non-delirious group, but this difference was not statistically significant (p=0.382). @*Conclusion@#Patients with delirium after TBI had significantly different injury site and side, but not lesion size compared to patients without delirium.
ABSTRACT
Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.
ABSTRACT
Purpose@#The immunomodulatory effects of thalidomide (TM) and dexamethasone (DX) on immune cells and their co-stimulatory, co-inhibitory molecules in vitro and in vivo have been previously reported. The current study investigated the effects of TM and the combinatorial treatment with DX on immune cells using a murine cardiac allograft transplantation model. @*Materials and Methods@#Intraabdominal transplant of cardiac allografts from BALB/c (H-2d ) donors to C57BL/6 (H-2b ) recipients was performed. After transplantation, mice were injected daily with TM or DX or a combination of both TM and DX (TM/DX) by intraperitoneal route until the time of graft loss. CD4+ T cell subsets and CD11c+ cells in the peripheral blood mononuclear cells and spleen were examined and quantified with flow cytometry. Serum IL-6 levels were measured by enzyme-linked immunosorbent assay on day 7. @*Results@#The mean graft survivals were 6.86 days in the untreated group, and 10.0 days in the TM/DX group (p<0.001). The TM/DX treatment affected the CD4+ T cell subsets without suppressing the total CD4+ T cell population. The CD4 + FOXP3+ /CD4+ CD44hi T cell ratio increased. Increase in cell counts and median fluorescence intensity on CD11c+ CD85k+ with TM/DX were observed. The inhibition of pro-inflammatory cytokine interleukin-6 was also observed. @*Conclusion@#These outcomes suggest the immunomodulating effect of the TM/DX combinatorial treatment. In conclusion, TM/ DX combination may be a promising immunomodulatory approach for preventing allograft rejection and improving graft survival by inducing tolerance in transplantation.
ABSTRACT
Background/Aims@#Some cases of gastric low-grade dysplasia (LGD) and high-grade dysplasia (HGD) on forceps biopsy (FB) are diagnosed as gastric cancer (GC) after endoscopic resection (ER). This study aims to evaluate the clinical outcomes of ER for gastric LGD and HGD on pretreatment FB and to identify the factors that predict pathologic upstaging to GC. @*Methods@#Patients who underwent ER for LGD and HGD on pretreatment FB from March 2005 to February 2018 in 14 hospitals in South Korea were enrolled, and the patients’ medical records were reviewed retrospectively. @*Results@#This study included 2,150 cases of LGD and 1,534 cases of HGD diagnosed by pretreatment FB. In total, 589 of 2,150 LGDs (27.4%) were diagnosed as GC after ER. Helicobacter pylori infection, smoking history, tumor location in the lower third of the stomach, tumor size >10 mm, depressed lesion, and ulceration significantly predicted GC. A total of 1,115 out of 1,534 HGDs (72.7%) were diagnosed with GC after ER. Previous history of GC, H. pylori infection, smoking history, tumor location in the lower third of the stomach, tumor size >10 mm, depressed lesion, and ulceration were significantly associated with GC. As the number of risk factors predicting GC increased in both LGD and HGD on pretreatment FB, the rate of upstaging to GC after ER increased. @*Conclusions@#A substantial proportion of LGDs and HGDs on pretreatment FB were diagnosed as GC after ER. Accurate ER procedures such as endoscopic submucosal dissection should be recommended in cases of LGD and HGD with factors predicting pathologic upstaging to GC.
ABSTRACT
Background and Objectives@#Treatment using systemic antibiotic administration and surgical drainage has been the common treatment modality for deep neck infection. This study compared the changing pattern of isolated pathogens to recommend the best empirical antibiotics for deep neck infection.Subjects and Method Reviewed retrospectively were medical charts of 131 patients who, confirmed with deep neck infection, underwent surgical drainage for pus cultures at Ewha Womans University Medical Center between January, 2009 and July, 2019. We analyzed the changing pattern of isolated pathogens and antibiotic susceptibility tests using their pus cultures. @*Results@#Streptococcus viridans was the most commonly isolated organism (35.1%), followed by Klebsiella pneumonia (13.7%) and Staphylococcus aureus (4.6%). The isolation rate of Streptococcus viridans increased in the recent 10 years [p=0.016, odds ratio (OR)=3.417]. Antibiotic susceptibility tests showed that all pathogens were resistant to ampicillin, but susceptible to ampicillin/sulbactam and cephalosporin. The isolation rate of clindamycin resistant pathogens was increased with statistical significance (p=0.020, OR=8.076). @*Conclusion@#Antibiotics effective against both Streptococcus viridans and Klebsiella pneumonia should be used as the first-line of treatment for deep neck infection. Ampicillin/sulbactam or amoxicillin/clavulanic acid were sufficient to treat deep neck infection empirically regardless of age or underlying diseases.
ABSTRACT
Background and Objectives@#There has been a long debate on whether intraoperative parathyroid hormone (IOPTH) monitoring is mandatory or not in the excision of a single abnormal parathyroid gland. The aim of this study is to suggest a new criteron of IOPTH monitoring. Subjects and Method We retrospectively analyzed 31 patients who underwent parathyroidectomy from 2005 to 2019. Patients had IOPTH not measured and those with secondary hyperparathyroidism were excluded. IOPTH was measured preoperatively (EX00), at 10 minutes (EX10) and 20 minutes (EX20) after the excision and analyzed. We determined the surgery as a ‘successful excision of lesion (SEOUL)’ when it met the following criteria: criterion 1) the level of EX10 or EX20 decreased under the upper normal or under upper limit of parathyroid hormone (65 pg/mL); criterion 2) EX20 decreased below 50% of EX00 and less than 195 pg/ mL (3 times the upper normal limit); criterion 3) multiglandular disease. @*Results@#Twenty-five patients among 31 patients were included this study (M:F=8:17). Twenty- two patients were suspected of single lesion and three patients of multiple lesions on preoperative images (99mTc-sestamibi scan, neck CT, and PET-CT). IOPTH of EX00, EX10, and EX20 were 488.92±658.74, 121.36±134.73, and 92.44±111.55 pg/mL, respectively. Sixty-four percent patients (16/25) met the criterion 1. Six patients (24%) successfully excised a lesion meeting the criterion 2. Three patients had multiglandular disease, meeting the criterion 3. @*Conclusion@#Our new criteria suggest when we could stop the procedure. If the level of IOPTH does not meet the SEOUL criteria, it means that there might be more lesions.
ABSTRACT
Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1–2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.
ABSTRACT
Purpose@#The purpose of this study was to develop and examine the effects of a simulation learning module based on schizophrenic patients care on the knowledge of schizophrenic patients care, learning self-efficacy, and nursing skill performance of nursing students. @*Methods@#Junior nursing students with no mental health nursing experience from two different colleges in G city participated. A total of 64 participants were classified into the experimental group (31) and the control group (33). This study was conducted based on the Jeffries simulation model, and the simulation learning module based on schizophrenic patient care was developed based on the Instructional System Design simulation learning module based on schizophrenic patients care comprising the module I lecture, the module II case-based team learning, and the module III standardized patient-based simulation learning. @*Results@#There were significant increases in the knowledge of schizophrenic patients care (t=2.85, p=.006), learning self-efficacy (t=3.42, p=.001) and nursing skill performance (t=16.69, p<.001) in the experimental group compared to the control group @*Conclusion@#The simulation learning module based on schizophrenic patients care can be useful in the educational and clinical environment as effective strategies in contributing to nursing education and clinical changes.
ABSTRACT
Background/Aims@#Little is known about the national colonoscopy volume in Asian countries. This study aimed to assess the national colonoscopy volume in Korea over a 12-year period on the basis of a nationwide population-based database. @*Methods@#We conducted a population-based study for colonoscopy claims (14,511,158 colonoscopies performed on 13,219,781 patients) on the basis of the Korean National Health Insurance Service database from 2002 to 2013. The 12-year national colonoscopy burden was analyzed according to patient age, patient sex, and healthcare facility type. @*Results@#The overall volume of colonoscopy increased 8-fold over the 12-year period. The annual colonoscopic polypectomy rate significantly increased in all patient sex and age groups over the 12-years period (all p<0.001). The yearly colonoscopic polypectomy rate for men was significantly increased compared with that for women (2.3% vs 1.7%, p<0.001) and for the screening-age group compared with that for the young-age group (2.0% vs 1.6%, p<0.001). The yearly colonoscopic polypectomy rate relative to the total colonoscopy volume significantly increased in primary, secondary, and tertiary facilities by 2.4%, 1.9%, and 1.4% during the 12-year period (all p<0.001). In addition, the annual colonoscopy volume covered by high-volume facilities significantly increased by 1.8% in primary healthcare facilities over the 12-year period (p<0.001). @*Conclusions@#Healthcare resources should be prioritized to allow adequate colonoscopic capacity, especially for men, individuals in the screening-age group, and at primary healthcare facilities. Cost-effective strategies to improve the quality of colonoscopy may focus on primary healthcare facilities and high-volume facilities in Korea.
ABSTRACT
Background@#Previous research has shown a beneficial effect of prewarming for preventing inadvertent perioperative hypothermia. However, there are few studies of the effects of a short prewarming period, especially in gynecologic laparoscopic surgery. @*Methods@#Fifty-four patients were randomly assigned to 2 groups. Patients in the non-prewarming group were only warmed intraoperatively with a forced air warming device, while those in the prewarming group were warmed for 10 min before anesthetic induction and during the surgery. The primary outcome was incidence of intraoperative hypothermia. @*Results@#Intraoperative hypothermia was observed in 73.1% of the patients in the non-prewarming group and 24% of the patients in the prewarming group (P < 0.001). There were significant differences in core temperature changes between the groups (P < 0.001). Postoperative shivering occurred in 8 of the 26 (30.8%) patients in the non-prewarming group and in 1 of the 25 (4.0%) patients in the prewarming group (P = 0.024). @*Conclusions@#Forced air warming for 10 min before induction on the operating table combined with intraoperative warming was an effective method to prevent hypothermia in patients undergoing gynecologic laparoscopic surgery.
ABSTRACT
OBJECTIVES: To identify factors related to physical health monitoring of patients with schizophrenia spectrum disorder. METHODS: A total of 172 patients with schizophrenia spectrum disorder registered in mental health welfare centers and rehabilitation facilities in Gwangju were recruited. Physical health monitoring was defined by two health behaviors; fasting blood tests within recent 2 years in all participants and routine medical check-ups covered by national insurance within recent 5 years in participants aged 40 years or older. Demographic and clinical characteristics including overweight, metabolic syndrome and knowledge about physical illness were compared according to physical health monitoring. RESULTS: Prevalence of overweight and metabolic syndrome were 62.8% and 40.1%, respectively. The rates of fasting blood tests and routine medical check-ups were 34.9% and 67.9%, respectively. The rates of fasting blood tests were significantly higher in general hospital and university hospital compared to mental hospital or private clinic. Rates of routine medical check-ups were significantly lower in individuals using daily rehabilitation service and smokers. Knowledge about cancer and chronic illness were significantly better in individuals receiving routine medical check-ups compared with those not receiving it. CONCLUSION: Education about physical health should be integrated to mental health service in community mental health center.
Subject(s)
Humans , Chronic Disease , Education , Fasting , Health Behavior , Hematologic Tests , Hospitals, General , Hospitals, Psychiatric , Insurance , Mental Health , Mental Health Services , Overweight , Prevalence , Rehabilitation , Schizophrenia , SmokingABSTRACT
Peripheral giant cell granuloma (PGCG) is an benign non-neoplastic lesion most commonly occurring in oral cavity but extraoral PGCG is extremely rare. Recently, we experienced a case of an isolated PGCG in the parotid gland in 59-year-old man. FNAB findings and radiologic findings including CT and US were suggestive of Warthin's tumor. Partial parotidectomy was performed. Pathologic findings showed fibrillar connective tissue stroma with spindled, ovoid, and round histiocytes-like cells mixed with uneven multinuclear giant cells, small capillaries, hemorrhage, hemosiderin-laden macrophages, and necrosis which were consistent with giant cell granuloma. We report a case of an PGCG in parotid with a review of literature.
Subject(s)
Humans , Middle Aged , Capillaries , Connective Tissue , Giant Cells , Granuloma, Giant Cell , Hemorrhage , Macrophages , Mouth , Necrosis , Parotid GlandABSTRACT
Intraductal papilloma is an extremely rare benign tumor especially when it arises from major salivary gland. Recently, we experienced a case of an intraductal papilloma arising from the parotid gland in a 51-year-old woman. The radiologic finding showed lobulated enhancing and cystic solid mass in the left parotid superficial lobe. Superficial parotidectomy was performed. Pathological findings showed papillary proliferations with fibrovascular cores lined with bland cuboidal or columnar epithelial cells, and immunohistochemical stain results were consistent with intraductal papilloma. We report a case of intraductal papilloma in parotid gland with a review of literature.
Subject(s)
Female , Humans , Middle Aged , Epithelial Cells , Papilloma, Intraductal , Parotid Gland , Salivary GlandsABSTRACT
Acute myocarditis is clinically rare in children, but poses a significant risk for morbidity and mortality. Children with myocarditis show a wide variety of clinical manifestations ranging from subclinical myocarditis to heart failure, hemodynamic compromise, arrhythmia, and even sudden death. Salmonella species are associated with clinical presentations including gastroenteritis, enteric fever, bacteremia, and extra-intestinal focal infections. Non-typhoidal Salmonella infections usually cause self-limiting gastroenteritis, but are rarely associated with myocarditis. In this report, we present a case of myocarditis associated with Salmonella serogroup B gastroenteritis in a previously healthy 15-year-old boy.
Subject(s)
Adolescent , Child , Humans , Male , Arrhythmias, Cardiac , Bacteremia , Death, Sudden , Focal Infection , Gastroenteritis , Heart Failure , Hemodynamics , Magnetic Resonance Imaging , Mortality , Myocarditis , Salmonella Infections , Salmonella , Serogroup , Typhoid FeverABSTRACT
PURPOSE: This study was conducted to examine the effects of a communication empowerment program based on situated learning theory for nursing students. METHODS: A non-equivalent control group pretest-posttest design was used. The study participants were 61 nursing students (31 in the experimental group and 30 in the control group) from G city. Data were collected from November 3, 2015 to December 10, 2015. The experimental group received eight sessions of the program, which were scheduled twice a week, with each session lasting two hours. The data were analyzed using chi-square test, Fisher's exact test, and an independent t-test using SPSS/WIN 20.0. RESULTS: There were significant increases in self-efficacy for communication (t=2.62, p=.011), emotional intelligence (t=2.66, p=.010), and interpersonal communication competence (t=2.87, p=.006) in the experimental group compared to the control group. CONCLUSION: Based on the findings, our study suggests a need to include content from communication curricula or clinical communication training programs for improving undergraduate nursing students' communication skills in practice settings.
Subject(s)
Humans , Curriculum , Education , Emotional Intelligence , Learning , Mental Competency , Nursing , Power, Psychological , Students, NursingABSTRACT
Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology (KSThR) developed recommendations for the optimal use of radiofrequency ablation for thyroid tumors in 2012. As new meaningful evidences have accumulated, KSThR decided to revise the guidelines. The revised guideline is based on a comprehensive analysis of the current literature and expert consensus.
Subject(s)
Humans , Advisory Committees , Catheter Ablation , Consensus , Thyroid Gland , Thyroid Neoplasms , Thyroid Nodule , UltrasonographyABSTRACT
Palatal myoclonus (PM) is a rare disease that may induce dysphagia. Since dysphagia related to PM is unique and is characterized by myoclonic movements of the involved muscles, specific treatments are needed for rehabilitation. However, no study has investigated the treatment effectiveness for this condition. Therefore, the aim of this case report was to describe the benefit of combining behavioral treatment with valproic acid administration in patients with dysphagia triggered by PM. The two cases were treated with combined treatment. The outcomes evaluated by videofluoroscopic swallowing studies before and after the treatment showed significant decreases in myoclonic movements and improved swallowing function. We conclude that the combined treatment was effective against dysphagia related to PM.
Subject(s)
Humans , Deglutition , Deglutition Disorders , Muscles , Myoclonus , Rare Diseases , Rehabilitation , Stroke , Treatment Outcome , Valproic AcidABSTRACT
PURPOSE: The purpose of this study was to evaluate the diagnostic efficacy of fine-needle aspiration (FNA), core needle biopsy (CNB), and combined FNA/CNB for the first-line diagnosis of thyroid nodules. METHODS: A total of 782 consecutive nodules that underwent simultaneous FNA and CNB were analyzed in this study. We compared the rate of inconclusive results and the diagnostic values for malignancy among FNA, CNB, and combined FNA/CNB. RESULTS: CNB showed a lower rate (10.2%) of inconclusive results than FNA (23.7%) (P < 0.001). Combined FNA/CNB showed a lower rate (6.5%) of inconclusive results than FNA (all nodules, P < 0.001; macronodules, P < 0.001; and micronodules, P < 0.001, respectively) or CNB (all nodules, P < 0.001; macronodules, P < 0.001; and micronodules, P=0.003, respectively). Combined FNA/CNB and CNB showed significantly higher sensitivity, accuracy, and diagnostic performance for malignancy as defined by criterion 1 (Bethesda category VI) or criterion 2 (Bethesda categories IV/V/VI) than FNA (P < 0.001). However, there was no significant difference in the sensitivity, accuracy, or diagnostic performance between combined FNA/CNB and CNB (with criterion 1, P=0.063, P=0.063, and P=0.412, respectively; with criterion 2, P=0.500, P=0.500, and P=0.348, respectively). CONCLUSION: CNB was found to be more effective than FNA for the diagnosis of thyroid nodules, and its sensitivity and diagnostic performance for malignancy were similar to those of combined FNA/CNB. CNB has the potential to be an effective alternative first-line diagnostic tool for thyroid nodules when performed by an experienced operator.