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1.
Article in Korean | WPRIM | ID: wpr-750266

ABSTRACT

PURPOSE: This study was done to develop an evidence-based nursing clinical practice guideline for Moisture associated skin damage (MASD) prevention and management for patients in Korea. METHODS: The guideline adaptation process was used and conducted according to the guideline adaptation manual developed by the Korean Hospital Nurses Association. It consists of three main phases and 9 modules including a total of 24 steps. RESULTS: The adapted MASD clinical practice guideline consisted of 4 sections, 8 domains and 28 recommendations. The number of recommendations in each section was: 7 on MASD assessment, 14 on MASD prevention and management, 4 on education, and 3 on organizational policy. Of the recommendations, 3.6% were marked as A grade, 28.6% as B grade, and 67.8% as C grade. CONCLUSION: This MASD clinical practice guideline is the first to be developed in Korea. The developed guideline will contribute to standardized and consistent MASD prevention and management. The guideline can be recommended for dissemination and utilization by nurses nationwide to improve the quality of MASD prevention and management. Regular revision is recommended.


Subject(s)
Dermatitis, Irritant , Education , Evidence-Based Nursing , Evidence-Based Practice , Humans , Intertrigo , Korea , Organizational Policy , Skin Care , Skin
2.
Korean Circulation Journal ; : 270-277, 2017.
Article in English | WPRIM | ID: wpr-59335

ABSTRACT

Genetic diagnosis of cardiomyopathies is challenging, due to the marked genetic and allelic heterogeneity and the lack of knowledge of the mutations that lead to clinical phenotypes. Here, we present the case of a large family, in which a single TNNI3 mutation caused variable phenotypic expression, ranging from restrictive cardiomyopathy (RCMP) to hypertrophic cardiomyopathy (HCMP) to near-normal phenotype. The proband was a 57-year-old female with HCMP. Examining the family history revealed that her elder sister had expired due to severe RCMP. Using a next-generation sequencing-based gene panel to analyze the proband, we identified a known TNNI3 gene mutation, c.433C>T, which is predicted to cause an amino acid substitution (p.Arg145Trp) in the highly conserved inhibitory region of the cardiac troponin I protein. Sanger sequencing confirmed that six relatives with RCMP or near-normal phenotypes also carried this mutation. To our knowledge, this is the first genetically confirmed family with diverse phenotypic expression of cardiomyopathies in Korea. Our findings demonstrate familial implications, where a single mutation in a sarcomere protein can cause diverse phenotypic expression of cardiomyopathies.


Subject(s)
Amino Acid Substitution , Cardiomyopathies , Cardiomyopathy, Hypertrophic , Cardiomyopathy, Restrictive , Diagnosis , Female , Humans , Korea , Middle Aged , Phenotype , Population Characteristics , Sarcomeres , Siblings , Troponin I
3.
Journal of Stroke ; : 304-311, 2016.
Article in English | WPRIM | ID: wpr-193773

ABSTRACT

BACKGROUND AND PURPOSE: Left atrial dysfunction has been reported in patients with patent foramen ovale (PFO). Here we investigated the role of left atrial dysfunction in the development of embolic stroke in patients with PFO. METHODS: We identified consecutive patients with embolic stroke of undetermined sources except for PFO (PFO+ESUS). Healthy subjects with PFO served as controls (PFO+control). A stratified analysis by 10-year age group and an age- and sex- matching analysis were performed to compare echocardiographic markers between groups. In the PFO+ESUS group, infarct patterns of PFO-related stroke were determined (cortical vs. cortico-subcortical) and analyzed in correlation with left atrial function parameters. RESULTS: A total of 118 patients and 231 controls were included. The left atrial volume indices (LAVIs) of the PFO+ESUS patients were higher than those of the PFO+controls in age groups of 40–49, 50–59, and 60–69 years (P28 mL/m2) LAVI was more associated with the cortical infarct pattern (P=0.043 for an acute infarction and P=0.024 for a chronic infarction, both adjusted for age and shunt amount). The degree of right-to-left shunting was not associated with infarct patterns, but with the posterior location of acute infarcts (P=0.028). CONCLUSIONS: Left atrial enlargement was associated with embolic stroke in subjects with PFO. Left atrial physiology might contribute to the development of PFO-related stroke and need to be taken into consideration for optimal prevention of PFO-related stroke.


Subject(s)
Atrial Function, Left , Echocardiography , Embolism , Embolism, Paradoxical , Foramen Ovale, Patent , Healthy Volunteers , Heart Atria , Humans , Infarction , Physiology , Stroke
4.
Article in English | WPRIM | ID: wpr-180427

ABSTRACT

A 53-yr-old man underwent radiofrequency ablation to treat persistent atrial flutter. After the procedure, the chest pain was getting worse, and the electrocardiogram showed ST-segment elevation in inferior leads with reciprocal changes. Immediate coronary angiography showed total occlusion with thrombi at the distal portion of the right coronary artery, which was very close to the ablation site. Intervention with thrombus aspiration and balloon dilatation was successful, and the patient recovered without any kind of sequelae. Although the exact mechanism is obscure, the most likely explanation is a thermal injury to the vascular wall that ruptured into the lumen and formed thrombus. Vasospasm and thromboembolism can also be other possibilities. This case raise the alarm to cardiologists who perform radiofrequency ablation to treat various kinds of cardiac arrhythmias, in that myocardial infarction has been rarely considered one of the complications.


Subject(s)
Acute Disease , Angioplasty, Balloon, Coronary , Atrial Flutter/surgery , Catheter Ablation/adverse effects , Chest Pain/etiology , Coronary Occlusion/etiology , Coronary Vessels/diagnostic imaging , Humans , Male , Middle Aged , Myocardial Infarction/diagnosis , Thrombosis/surgery
5.
Article in English | WPRIM | ID: wpr-199240

ABSTRACT

Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of non-Hodgkin lymphoma. It usually presents with nonspecific symptoms, such as fever, rather than with overt lymphadenopathy. Reports of hypercalcemia, as the initial presentation of IVLBCL, are limited in the literature, despite it being a well-known complication of various solid cancers. We present a 68-year-old male with severe hypercalcemia and increased levels of serum parathyroid hormone-related protein. He was diagnosed with IVLBCL, involving the bone marrow and spleen, and was successfully treated with rituximab-containing chemotherapy. A few previous case reports have shown hypercalcemia in patients with IVLBCL. Much like our case, previous cases with hypercalcemia had advanced diseases, including bone marrow invasion. Although it was an extremely rare manifestation of IVLBCL, we suggest that IVLBCL should be a part of the differential diagnosis in patients with unexplained hypercalcemia. Therefore, an active work-up might be recommended, including positron emission tomography/computed tomography scan and bone marrow examination, which may be useful for early diagnosis.


Subject(s)
Aged , Bone Marrow , Bone Marrow Examination , Diagnosis, Differential , Drug Therapy , Early Diagnosis , Electrons , Fever , Humans , Hypercalcemia , Lymphatic Diseases , Lymphoma, B-Cell , Lymphoma, Non-Hodgkin , Male , Parathyroid Hormone-Related Protein , Spleen
6.
Korean Journal of Medicine ; : 739-743, 2014.
Article in Korean | WPRIM | ID: wpr-85491

ABSTRACT

Amyloidosis can be identified by the deposition of amyloid fibrils in biopsy specimens from multiple organs, including the heart, kidney, skin, and bowel. Systemic amyloid protein A amyloidosis (AA amyloidosis) is commonly associated with chronic inflammatory diseases or chronic infectious conditions. Cardiac involvement in AA amyloidosis is found in < 1% of reported cases. Here, we report a case of cardiac AA amyloidosis confirmed by heart biopsy in a 54-year-old-female with a medical history of rheumatoid arthritis and stage 4 chronic kidney disease due to renal amyloidosis. She had suffered from progressive aggravation of dyspnea for 2 years. Infiltrative disease involving the heart was suspected by echocardiography, and the patient was diagnosed with AA amyloidosis involving the heart by cardiac biopsy. This is a rare case of cardiac involvement in a patient with systemic AA amyloidosis associated with rheumatoid arthritis.


Subject(s)
Amyloid , Amyloidosis , Arthritis, Rheumatoid , Biopsy , Dyspnea , Echocardiography , Heart Failure , Heart , Humans , Kidney , Renal Insufficiency, Chronic , Rheumatic Fever , Skin , Staphylococcal Protein A
7.
Korean Journal of Urology ; : 460-464, 2014.
Article in English | WPRIM | ID: wpr-178075

ABSTRACT

PURPOSE: This study aimed to improve prostate biopsy compliance by analyzing the factors that influence the acceptance of prostate biopsy by patients to whom transrectal ultrasound (TRUS)-guided prostate biopsy is recommended for suspected prostate cancer. MATERIALS AND METHODS: The subjects of this study were 268 patients to whom TRUS-guided prostate biopsy was recommended from January to June 2011 and who completed a questionnaire. Patients who showed a prostate-specific antigen (PSA) increase to more than 4.0 ng/mL or abnormal findings on a digital rectal examination and TRUS were recommended to undergo prostate biopsy. The questionnaire consisted of 9 questions about the subjects' demographic characteristics and 15 questions that assessed their knowledge of prostate disease. Fisher exact probability test was conducted to assess the influence of the demographic characteristics and levels of knowledge of prostate disease on acceptance of prostate biopsy. RESULTS: The mean age of the subjects was 66.2 years (range, 43-83 years). Of the cohort, 188 patients (70.7%) agreed to the prostate biopsy and 78 patients (29.3%) refused. In terms of demographic characteristics, the patients' acceptance of prostate biopsy was associated only with education level. Patients with relatively lower education levels had a higher acceptance rate for prostate biopsy (80.0% vs. 65.9%, p=0.018). Other demographic factors, as well as the degree of knowledge of prostate disease, had no significant effect on the acceptance rate. CONCLUSIONS: The patients' acceptance of prostate biopsy can be influenced by demographic characteristics, especially education level. Therefore, when prostate biopsy is recommended to patients, their demographic characteristics should be taken into consideration.


Subject(s)
Adult , Aged , Aged, 80 and over , Biopsy, Needle/methods , Health Knowledge, Attitudes, Practice , Humans , Kallikreins/blood , Male , Middle Aged , Patient Acceptance of Health Care , Prospective Studies , Prostate-Specific Antigen/blood , Prostatic Neoplasms/pathology , Republic of Korea , Socioeconomic Factors , Ultrasonography, Interventional
8.
Article in Korean | WPRIM | ID: wpr-192744

ABSTRACT

Churg-Strauss syndrome (CSS) is a rare systemic vasculitis. It is characterized by peripheral eosinophilia, asthma, neuropathy, skin manifestation, and less frequently gastrointestinal tract symptoms. Here we report a case of CSS which is initially manifested as acute acalculous cholecystitis. A 67-year-old asthmatic woman visited Emergency Room because of acute abdominal pain. Computed tomography showed acalculous cholecystitis and laparoscopic cholecystectomy was done. Pathology of gallbladder showed marked eosinophilic infiltration with necrotizing vasculitis and granuloma. On the basis of asthma, sinusitis, lung infiltration, combined peripheral eosinophilia and neuropathy, the patient was diagnosed as CSS. To our knowledge, this is the first case of pathologically proven eosinophilic cholecystitis in Korea.


Subject(s)
Abdominal Pain , Acalculous Cholecystitis , Aged , Asthma , Cholecystectomy, Laparoscopic , Cholecystitis , Churg-Strauss Syndrome , Emergencies , Eosinophilia , Eosinophils , Female , Gallbladder , Gastrointestinal Tract , Granuloma , Humans , Korea , Lung , Pathology , Sinusitis , Skin Manifestations , Systemic Vasculitis , Vasculitis
9.
Article in Korean | WPRIM | ID: wpr-169735

ABSTRACT

BACKGROUND/AIMS: Crohn's disease is a chronic inflammatory bowel disease. Stricture is a very important indication for surgical intervention as strictures can lead to intestinal obstruction. Strictures can be divided into inflammatory and fibrous strictures. Intestinal obstruction due to inflammatory stricture is expected to be resolved with medical treatment. However, factors that can predict the response to medical treatments are unknown. In the present study, we aimed to identify the factors that can predict the response to medical treatments in Crohn's disease patients with intestinal obstruction. METHODS: Data were collected by retrospectively reviewing the medical records of patients with Crohn's disease who visited the emergency department at Samsung Medical Center in Seoul from January 1, 2000 to December 31, 2010 because of intestinal obstruction. Based on the response to medical treatments, we classified the patients as responders and non-responders and compared the clinical, biochemical, and radiological findings of the two groups. RESULTS: A total of 39 patients were enrolled. Twenty-nine patients responded to medical treatments whereas 10 patients did not. Significant differences were observed between the two groups in terms of vomiting and duration of disease before the development of obstruction. CONCLUSIONS: Patients who responded to the medical treatments exhibited a higher incidence of vomiting and longer duration of disease before the development of obstruction. However, further prospective studies are needed to identify the factors that can predict the response to medical treatments.


Subject(s)
Adolescent , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , C-Reactive Protein/analysis , Crohn Disease/complications , Female , Follow-Up Studies , Humans , Intestinal Obstruction/etiology , Leukocytes/cytology , Male , Middle Aged , Retrospective Studies , Risk Factors , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Young Adult
10.
Article in English | WPRIM | ID: wpr-77368

ABSTRACT

Methcillin-resistant Staphylococcus aureus (MRSA) has emerged as an important cause of community-acquired infections, which has been recently designated as community-associated (CA) MRSA. Panton-Valentine leukocidin (PVL)-negative multilocus sequence type 72 (ST72)-staphylococcal cassette chromosome mec (SCCmec) type IV has been reported as the predominat CA-MRSA strain in Korea and is commonly associated with skin and soft tissue infections in addition to healthcare-associated pneumonia. However, community-acquired pneumonia (CAP) for this strain has not yet been reported. We hereby report two cases of CAP caused by PVL-negative ST72-SCCmec type IV strain in patients who had no risk factors for MRSA acquisition. While CA-MRSA infections are not yet prevalent in Korea, our cases suggest that CA-MRSA should be considered in cases of severe CAP, especially for cases associated with necrotizing pneumonia.


Subject(s)
Bacterial Toxins , Community-Acquired Infections , Exotoxins , Humans , Korea , Leukocidins , Methicillin-Resistant Staphylococcus aureus , Pneumonia , Risk Factors , Skin , Soft Tissue Infections , Sprains and Strains , Staphylococcus , Staphylococcus aureus
11.
Article in English | WPRIM | ID: wpr-9504

ABSTRACT

The cardiovascular system may be one of the target organs of both immunoglobulin G4 related and non-related systemic multifocal fibrosclerosis. We present a case of IgG4 non-related systemic multifocal fibrosclerosis mimicking mitral stenosis on echocardiography. For a more detailed differential diagnosis, we used multimodal imaging techniques. After surgical biopsy around the abdominal aortic area in the retroperitoneum, histological examination revealed IgG4 non-related systemic multifocal fibrosclerosis. We describe the multimodal imaging used to diagnose IgG4 non-related systemic multifocal fibrosclerosis and a positive response to steroid treatment. There have been no previous case reports of IgG4 non-related systemic multifocal fibrosclerosis with intracardiac involvement. Here, we report a case of IgG4 non-related systemic multifocal fibrosclerosis mimicking mitral stenosis.


Subject(s)
Aged , Aorta, Abdominal/pathology , Diagnosis, Differential , Echocardiography , Female , Humans , Immunoglobulin G/blood , Magnetic Resonance Imaging , Mitral Valve Stenosis/diagnosis , Myocardium/pathology , Peritoneum/surgery , Positron-Emission Tomography , Retroperitoneal Fibrosis/congenital , Steroids/therapeutic use , Tomography, X-Ray Computed
12.
Korean Journal of Medicine ; : 243-246, 2011.
Article in English | WPRIM | ID: wpr-47585

ABSTRACT

We present the first case of enthesitis in the lumbar spine in a woman with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Enthesopathy is defined as pathological alterations at the site of insertion of a tendon, ligament, joint capsule, or fascia to bone. In particular, enthesitis is the universal hallmark of seronegative spondyloarthropathies (SpA), including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and spondyloarthropathies associated with inflammatory bowel diseases. A 36-year-old female SLE patient with a history of lupus nephritis and thrombosis from APS presented with low back pain that had been gradually worsening for several months. She reported no previous episodes of trauma. Plain radiography indicated sclerosis at the anterior superior bodies of L3 and L5. Magnetic resonance imaging (MRI) showed low-intensity lesions on T1-weighted images and high-intensity lesions on T2-weighted images at the anterior superior bodies of L3, L4, and L5, consistent with osteitis or enthesitis. A nonsteroidal antiinflammatory drug (NSAID) was used as the first-line therapy in this patient, which improved her symptoms. This is the first report of enthesitis in the context of SLE. Although the possibility of coincidental occurrence of SpA and SLE cannot be excluded, the observations in this case suggest that enthesitis may be one of the manifestations of SLE.


Subject(s)
Adult , Antiphospholipid Syndrome , Arthritis, Psoriatic , Arthritis, Reactive , Collodion , Fascia , Female , Humans , Inflammatory Bowel Diseases , Joint Capsule , Ligaments , Low Back Pain , Lupus Erythematosus, Systemic , Lupus Nephritis , Magnetic Resonance Imaging , Osteitis , Rheumatic Diseases , Sclerosis , Spine , Spondylarthropathies , Spondylitis, Ankylosing , Tendons , Thrombosis
13.
Article in Korean | WPRIM | ID: wpr-193902

ABSTRACT

Hepatitis A is generally known as a mild, self-limiting disease of the liver, but in rare instances it can progress to fulminant hepatitis, which may require liver transplantation for recovery. Such cases are known to be related to old age and underlying liver disease. We report four cases of hepatitis A in which patients presented with fulminant hepatitis and acute renal failure and underwent liver transplantation. The following common features were observed in our cases: (1) occurrence in relatively old age (> or =39 years old), (2) association with acute renal failure, (3) presence of hepatomegaly, and (4) microscopic features of submassive hepatic necrosis.


Subject(s)
Adult , Age Factors , Female , Hepatitis/complications , Hepatitis A/complications , Hepatomegaly/diagnosis , Humans , Acute Kidney Injury/complications , Liver/pathology , Liver Cirrhosis/diagnosis , Liver Transplantation , Male , Tomography, X-Ray Computed
14.
Article in Korean | WPRIM | ID: wpr-67529

ABSTRACT

Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder that is characterized by multiple cutaneous vascular malformations in the skin and gastrointestinal tract and is associated with intestinal hemorrhage and iron deficiency anemia. This syndrome may induce severe or fatal bleeding; however, the causes of this syndrome are unknown. We report here a case of BRBNS that was diagnosed in a 20-year-old male with chronic anemia and a past history of surgery due to cutaneous hemangioma on the shoulder and thigh. One purplish hemangioma on the stomach and multiple bluish hemangiomas on the colon were noted on the endoscopic examination. We successfully treated the GI hemangioma with endoscopic band ligation and endoscopic polypectomy.


Subject(s)
Anemia , Anemia, Iron-Deficiency , Blister , Colon , Gastrointestinal Neoplasms , Gastrointestinal Tract , Hemangioma , Hemorrhage , Humans , Ligation , Male , Nevus , Nevus, Blue , Rubber , Shoulder , Skin , Skin Neoplasms , Stomach , Thigh , Vascular Malformations , Young Adult
15.
Article in Korean | WPRIM | ID: wpr-157049

ABSTRACT

PURPOSE: The present study was designed to understand the conceptual definition and attributes of the clinical critical thinking ability(CCTA) in nursing and to grasp the characteristics of clinical critical thinking abilities. METHODS: The data were analyzed using the Hybrid model of Schwartz-Barcott and Kim(2000). RESULTS: Having the skills and dispositions to think critically, CCTA refers to something that implies the cognizant ability to interpret contextual meanings, analyze the relationships between materials or circumstances, draw out the best conclusions, predict things using relevant information and evaluate the reliability of information and the strength of inference on the one hand and the emphatic disposition to be curious, open-minded, intellectually integral, systematic and creative and to reflect on things in contextual terms on the other. CONCLUSION: CCTA is characterized by clinical circumstances, such as guessing the reasons for facts, predicting things, connecting theory to practice and approaching individual situation in total terms as well as by the Korean circumstances, such as taking another person's perspective. Hence, this study proposes developing the tools to measure the clinical critical thinking ability and the strategies to improve the clinical critical thinking ability and seeking to verify their validity, on the basis of the findings.


Subject(s)
Chimera , Clinical Competence , Concept Formation , Hand , Hand Strength , Problem Solving , Thinking
17.
Article in Korean | WPRIM | ID: wpr-159945

ABSTRACT

PURPOSE: The purpose of this study was to develop an e-Learning program about medication for nurses to enhance nurses' medication performance ability and to analyze learners' responses after studying with this program. METHOD: For the development of the e-Learning program, the NBISD(Network Based Instructional Systems Design) model, suggested by Jung(1999) was applied as a basic model and the instruction design theory of Gagne & Briggs(1979) and ARCS theory of Keller(1983) were applied. After the operation of this program for one month to 34 new nurses, learners' responses were analyzed. RESULT: Learners' knowledge of medication was greatly improved after this program. In addition learners' satisfaction with the overall education program, help in field applicability, ease of screen shift and exploration, and tutor activities were high and the contents were regarded suitable for e-Learning. Many things were advantageous such as easy accessibility, easy understandability with pictures and flash animation, practical cases and feedback from a tutor. Provision of a supplementary handout and improvement of a tight time schedule were pointed out as things to be improved. CONCLUSION: This e-Learning program can be used effectively for medication education for registered nurses, student nurses, and new nurses.


Subject(s)
Pharmaceutical Preparations , Internet , Humans , Female , Education, Nursing , Computer-Assisted Instruction , Adult
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