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2.
Article in English | WPRIM | ID: wpr-915804

ABSTRACT

Background@#Polo-like kinase 4 (PLK4) is a serine/threonine protein kinase located in the centriole of the chromosome during the cell cycle. PLK4 overexpression has been described in a variety of many common human epithelial tumors. Conversely, PLK4 acts as a haploinsufficient tumor suppressor in some situations, highlighting the importance of strict regulation of PLK4 expression, activity, and function. Meanwhile, the importance of chemoradiation resistance in rectal cancer is being emphasized more than ever. We aimed to analyze PLK4 expression and the tumor regression grade (TRG) in patients with rectal cancer, treated with chemoradiotherapy (CRT). @*Methods@#A retrospective study was conducted on 102 patients with rectal cancer who received preoperative CRT. Immunohistochemistry for PLK4 in paraffin-embedded tissue was performed from the biopsy and surgical specimens. @*Results@#We found significant association between high expression of PLK4 and poor response to neoadjuvant CRT (according to both Mandard and The Korean Society of Pathologists TRG systems) in the pre-CRT specimens. Other clinicopathologic parameters did not reveal any correlation with PLK4 expression. @*Conclusions@#This study revealed an association between high expression of PLK4 in the pre-CRT specimens and TRG. Our results indicated that PLK4 could potentially be a new predictor for CRT effect in patients with rectal cancer.

3.
Article in English | WPRIM | ID: wpr-889757

ABSTRACT

Purpose@#We aimed to investigate the prognostic value of serum β2-microglobulin for patients with Burkitt lymphoma (BL) and to propose a risk-stratifying classification system. @*Materials and Methods@#A prospective registry-based cohort study of BL patients treated with dose-intensive or effective dose-adjusted chemotherapies (n=81) was conducted. Survival outcomes were compared based on previously reported risk groups and/or serum β2-microglobulin levels. A risk-stratifying classification system incorporating serum β2-microglobulin levels was proposed and validated in an independent validation cohort (n=60). @*Results@#The median age was 47 years, and 57 patients (70.4%) were male. Patients with high serum β2-microglobulin levels (> 2 mg/L) had significantly worse progression-free survival (PFS) and overall survival (OS) (p 2 mg/L) was independently associated with a shorter PFS (hazards ratio [HR], 3.56; p=0.047) and OS (HR, 4.66; p=0.043). The new classification system incorporating the serum β2-microglobulin level allowed the stratification of patients into three distinct risk subgroups with 5-year OS rates of 100%, 89.5%, and 62.5%. In an independent cohort of BL, the system was validated by stratifying patients with different survival outcomes. @*Conclusion@#Serum β2-microglobulin level is an independent prognostic factor for BL patients. The proposed β2-microglobulin–based classification system could stratify patients with distinct survival outcomes, which may help define appropriate treatment approaches for individual patients.

4.
Asian Oncology Nursing ; : 98-109, 2021.
Article in English | WPRIM | ID: wpr-889505

ABSTRACT

Purpose@#This study investigated the difficulties in end-of-life care and end-of-life care competency in nurses who take care of cancer patients. @*Methods@#In the mixed method, a structured questionnaire on end-of-life care stress and competency was conducted on 115 nurses caring for cancer patients, and 19 were interviewed for qualitative research. For the collected quantitative data, descriptive statistics were used. For the qualitative study, the contents of the interview were summarized and systematized using the content analysis method to derive the main themes. @*Results@#The mean end-of-life care stress was 4.08 points (out of 5) and the mean end-of-life care competency was 3.43 points (out of 5). Four themes and 11 sub-themes for the difficulties in end-of-life care were identified, and the four themes are as follows: (1) regret over limited end-of-life nursing, (2) different aspects of persistent emotional distress, (3) overloaded duty at the end-of-life (4) conflicts encountered in decision-making for life-sustaining treatment. Four themes and eight sub-themes for end-of-life care competency were identified, and the four themes are as follows: (1) empathy and listening skills, (2) communication skills, (3) clinical nursing experience and education, (4) clinical nursing competency. @*Conclusion@#It was confirmed that nurses caring for cancer patients had a high level of end-of-life care stress, and it is necessary to develop a program to reduce difficulties in end-of-life care and increase end-of-life care competency.

5.
Article in English | WPRIM | ID: wpr-903435

ABSTRACT

In the case of hemodynamically stable broad complex tachycardia, it is essential to evaluate the causes and to diagnose correctly in the selection of appropriate management and drugs. We report two neonates diagnosed with idiopathic ventricular tachycardia, which is extraordinarily rare. One presented with idiopathic fascicular ventricular tachycardia (right bundle branch block pattern with a superior axis), and the other presented with right ventricular outflow tract ventricular tachycardia (left bundle branch block pattern with an inferior axis). These two forms are representative of benign ventricular tachycardia. No features of cardiovascular shock were observed. While the recommended initial drug treatments are different, the conditions were well controlled by propranolol without the development of any adverse events. There was no recurrence of arrhythmia for several months in the outpatient clinic.

6.
Neonatal Medicine ; : 77-82, 2021.
Article in English | WPRIM | ID: wpr-902832

ABSTRACT

We present the case of a healthy 28-day-old female full-term neonate who was admitted to the neonatal intensive care unit for severe metabolic acidosis, hypoglycemia, and an initial sinus rhythm. The first diagnostic hypothesis was hypovolemic shock, and fluid resuscitation was started immediately. During fluid therapy, cardiovascular collapse occurred with supraventricular tachycardia. The latter was successfully treated with adenosine and beta-blockers. After 8 days, electrocardiography showed ventricular pre-excitation, and Wolff-Parkinson-White syndrome was diagnosed. A novel variant of the MYL2 gene that is related to hypertrophic cardiomyopathy and conduction defect was found after discharge. Cardiogenic shock should be considered, despite being a rare cause of shock in neonates.

7.
Neonatal Medicine ; : 22-28, 2021.
Article in English | WPRIM | ID: wpr-902825

ABSTRACT

Purpose@#Meconium obstruction of prematurity (MOP) predisposes premature infants to intestinal perforation and prolonged hospitalization if not diagnosed and treated promptly. A standard contrast enema is less effective to treat infants with distal ileal obstructions because the contrast may not reach the obstructed areas. In an effort to avoid risky surgery, we administered oral contrast media to seven clinically diagnosed patients with MOP whose obstructions were not relieved via conventional sonography-guided contrast enema. We retrospectively evaluated whether oral nonionic water-soluble contrast media relieves MOP. @*Methods@#Seven of 67 premature infants with MOP were administered oral contrast media from June 2015 to January 2019. Patients were followed-up radiographically for bowel distention and evacuation of contrast media after oral administration. We recorded radiographic improvements, meconium evacuation, time to first feeding after oral contrast media administration, maternal history, and neonatal clinical factors. @*Results@#We evaluated five male and two female infants. The median gestational ages and body weights at birth were 27+5 weeks and 890 g, respectively. Radiography in five infants revealed multiple distended intestinal loops without air-fluid interfaces. Two infants had gasless abdomens, in which only stomach gas was visible. Oral contrast media (median, 2.5 mL) were administered at a median age of 7 days; five infants (5/7, 71.4%) responded to this treatment. The remaining two infants, who had ileal stenosis and hypoganglionosis, were surgically managed. Five infants (5/7, 71.4%) had maternal risk factors, and two (28.6%) were small for gestational age. @*Conclusion@#Nonionic oral water-soluble contrast medium can serve as a valuable adjunct treatment in premature infants with meconium obstruction.

8.
Article in English | WPRIM | ID: wpr-902014

ABSTRACT

Background@#Scabies is a parasitic infection caused by the Sarcoptes scabiei var. hominis mite. Its incidence has been increasing in recent years; however, no study has evaluated the clinical aspects of scabies in children and adolescents in Korea. @*Objective@#To evaluate the clinical characteristics and epidemiological features of scabies among children and adolescents and to investigate the clinical efficacy of topical therapies for the treatment of scabies. @*Methods@#We retrospectively reviewed the medical records of 62 patients under 18 years of age with scabies during a 10-year-period. @*Results@#Sixty-two patients with 62 scabies were investigated. These patients showed scabies mites or eggs under microscopic examination or showed clinical improvement after treatment. There were 36 boys (58.1%) and 26 girls (41.9%). The mean age of the boys was 9.3 years and that of the girls was 8.2 years. The most common primary lesions were erythematous papules (93.5%), and the commonest sites of the skin lesions were the hand (64.5%) and the trunk (61.3%). The most common suspected mode of transmission was through contact among families living together. The mean time to complete treatment was 46.1 days using 1% gamma benzene hexachloride lotion, 37.1 days using 10% crotamiton ointment, and 22.8 days using 5% permethrin cream. @*Conclusion@#We confirmed the epidemiological features and clinical characteristics of scabies in children and adolescents, including contact sources and treatment. This study could provide useful data for the prevention and management of scabies in children and adolescents.

9.
Article in English | WPRIM | ID: wpr-901983

ABSTRACT

Background@#Bacterial skin soft-tissue infection is a common clinical manifestation in dermatology. The treatment of bacterial skin infections is often challenging due to antibiotic resistance, including methicillin resistance. @*Objective@#The aim of this study was to investigate the isolation rate of bacteria, antibiotic susceptibility, clinical features, and factors associated with treatment response in bacterial skin infections. @*Methods@#We retrospectively reviewed the medical records of patients who underwent ordinary bacterial skin cultures of the site of superficial skin infections between 2010 and 2019. @*Results@#A total of 1,298 patients were included in the study. The most commonly isolated bacteria were Staphylococcus aureus (31.3%), followed by coagulase-negative staphylococci (22.0%) and Pseudomonas species (4.2%). The methicillin-resistance rate of S. aureus was 22.7%. Crusted lesions (p=0.025), treatment with steroids (p=0.035), duration over 7 days (p=0.009), and isolation of Pseudomonas (p<0.001) or other uncommon species (non-Staphylococcus, Streptococcus, and Pseudomonas species, p<0.001) were significantly associated with treatment response. @*Conclusion@#The methicillin-resistance rate of S. aureus was similar to that of the past 5 years, but the mupirocin-resistance rate significantly increased. Lesions with crust or those that were treated with steroids showed good treatment responses, but longer disease durations of over 7 days and skin infections caused by Pseudomonas or other uncommon species were poor prognostic factors that should receive more attention.

10.
Article in English | WPRIM | ID: wpr-901956

ABSTRACT

Eczema herpeticum is a widespread herpes simplex infection that favors eczema-damaged skin, including skin involved with atopic dermatitis. Here we report a case of a 27-year-old woman who presented with febrile, painful, punched-out, erosive, macular eruptions and crusts on her face, upper trunk, and antecubital fossae. Polymerase chain reaction analyses of the blood and skin lesions were positive for type 1 herpes simplex virus, and blood cultures established on admission showed methicillin-sensitive Staphylococcus aureus. She was diagnosed with bacteremia superimposed on eczema herpeticum. True bacteremia rather than contaminated blood cultures was suspected because her fever did not improve after 2 days despite the administration of antivirals. Repeated scratches to the lesional skin most likely aggravated the epidermal barrier damage, enabling the penetration of the dermal vessels by colonized S. aureus.

11.
Article in English | WPRIM | ID: wpr-901944

ABSTRACT

Atypical fibroxanthoma (AFX) is a rare fibrohistiocytic tumor usually observed on ultraviolet light-exposed areas of the body, such as the face or scalp in elderly individuals. Despite its clinically benign course, AFX presents with malignant features on histopathological evaluation. A 12-year-old male adolescent presented with a 3-month history of an asymptomatic, skin-colored, oval-shaped nodule on his right thigh. Histopathological examination showed a dermal tumor adjacent to the epidermis, without epidermal invasion. The tumor was composed of numerous pleomorphic spindle cells and large atypical histiocytes with abundant vacuolated cytoplasm and pleomorphic nuclei. Immunohistochemical analysis revealed tumor cells, which were immunopositive for vimentin, CD68, CD10 and immunonegative for desmin, pan-cytokeratin antibody (AE1/AE3), and S-100. Therefore, the patient was diagnosed with AFX. We report a rare case of AFX that occurred on the thigh (an unusual site) in an adolescent (an uncommon age group). Immunohistochemical analysis is important in patients with suspected AFX, regardless of the patient’s age and site of lesion, for accurate diagnosis to differentiate this condition from other diseases with a similar presentation.

12.
Article in English | WPRIM | ID: wpr-897461

ABSTRACT

Purpose@#We aimed to investigate the prognostic value of serum β2-microglobulin for patients with Burkitt lymphoma (BL) and to propose a risk-stratifying classification system. @*Materials and Methods@#A prospective registry-based cohort study of BL patients treated with dose-intensive or effective dose-adjusted chemotherapies (n=81) was conducted. Survival outcomes were compared based on previously reported risk groups and/or serum β2-microglobulin levels. A risk-stratifying classification system incorporating serum β2-microglobulin levels was proposed and validated in an independent validation cohort (n=60). @*Results@#The median age was 47 years, and 57 patients (70.4%) were male. Patients with high serum β2-microglobulin levels (> 2 mg/L) had significantly worse progression-free survival (PFS) and overall survival (OS) (p 2 mg/L) was independently associated with a shorter PFS (hazards ratio [HR], 3.56; p=0.047) and OS (HR, 4.66; p=0.043). The new classification system incorporating the serum β2-microglobulin level allowed the stratification of patients into three distinct risk subgroups with 5-year OS rates of 100%, 89.5%, and 62.5%. In an independent cohort of BL, the system was validated by stratifying patients with different survival outcomes. @*Conclusion@#Serum β2-microglobulin level is an independent prognostic factor for BL patients. The proposed β2-microglobulin–based classification system could stratify patients with distinct survival outcomes, which may help define appropriate treatment approaches for individual patients.

13.
Asian Oncology Nursing ; : 98-109, 2021.
Article in English | WPRIM | ID: wpr-897209

ABSTRACT

Purpose@#This study investigated the difficulties in end-of-life care and end-of-life care competency in nurses who take care of cancer patients. @*Methods@#In the mixed method, a structured questionnaire on end-of-life care stress and competency was conducted on 115 nurses caring for cancer patients, and 19 were interviewed for qualitative research. For the collected quantitative data, descriptive statistics were used. For the qualitative study, the contents of the interview were summarized and systematized using the content analysis method to derive the main themes. @*Results@#The mean end-of-life care stress was 4.08 points (out of 5) and the mean end-of-life care competency was 3.43 points (out of 5). Four themes and 11 sub-themes for the difficulties in end-of-life care were identified, and the four themes are as follows: (1) regret over limited end-of-life nursing, (2) different aspects of persistent emotional distress, (3) overloaded duty at the end-of-life (4) conflicts encountered in decision-making for life-sustaining treatment. Four themes and eight sub-themes for end-of-life care competency were identified, and the four themes are as follows: (1) empathy and listening skills, (2) communication skills, (3) clinical nursing experience and education, (4) clinical nursing competency. @*Conclusion@#It was confirmed that nurses caring for cancer patients had a high level of end-of-life care stress, and it is necessary to develop a program to reduce difficulties in end-of-life care and increase end-of-life care competency.

14.
Article in English | WPRIM | ID: wpr-895731

ABSTRACT

In the case of hemodynamically stable broad complex tachycardia, it is essential to evaluate the causes and to diagnose correctly in the selection of appropriate management and drugs. We report two neonates diagnosed with idiopathic ventricular tachycardia, which is extraordinarily rare. One presented with idiopathic fascicular ventricular tachycardia (right bundle branch block pattern with a superior axis), and the other presented with right ventricular outflow tract ventricular tachycardia (left bundle branch block pattern with an inferior axis). These two forms are representative of benign ventricular tachycardia. No features of cardiovascular shock were observed. While the recommended initial drug treatments are different, the conditions were well controlled by propranolol without the development of any adverse events. There was no recurrence of arrhythmia for several months in the outpatient clinic.

15.
Neonatal Medicine ; : 77-82, 2021.
Article in English | WPRIM | ID: wpr-895128

ABSTRACT

We present the case of a healthy 28-day-old female full-term neonate who was admitted to the neonatal intensive care unit for severe metabolic acidosis, hypoglycemia, and an initial sinus rhythm. The first diagnostic hypothesis was hypovolemic shock, and fluid resuscitation was started immediately. During fluid therapy, cardiovascular collapse occurred with supraventricular tachycardia. The latter was successfully treated with adenosine and beta-blockers. After 8 days, electrocardiography showed ventricular pre-excitation, and Wolff-Parkinson-White syndrome was diagnosed. A novel variant of the MYL2 gene that is related to hypertrophic cardiomyopathy and conduction defect was found after discharge. Cardiogenic shock should be considered, despite being a rare cause of shock in neonates.

16.
Neonatal Medicine ; : 22-28, 2021.
Article in English | WPRIM | ID: wpr-895121

ABSTRACT

Purpose@#Meconium obstruction of prematurity (MOP) predisposes premature infants to intestinal perforation and prolonged hospitalization if not diagnosed and treated promptly. A standard contrast enema is less effective to treat infants with distal ileal obstructions because the contrast may not reach the obstructed areas. In an effort to avoid risky surgery, we administered oral contrast media to seven clinically diagnosed patients with MOP whose obstructions were not relieved via conventional sonography-guided contrast enema. We retrospectively evaluated whether oral nonionic water-soluble contrast media relieves MOP. @*Methods@#Seven of 67 premature infants with MOP were administered oral contrast media from June 2015 to January 2019. Patients were followed-up radiographically for bowel distention and evacuation of contrast media after oral administration. We recorded radiographic improvements, meconium evacuation, time to first feeding after oral contrast media administration, maternal history, and neonatal clinical factors. @*Results@#We evaluated five male and two female infants. The median gestational ages and body weights at birth were 27+5 weeks and 890 g, respectively. Radiography in five infants revealed multiple distended intestinal loops without air-fluid interfaces. Two infants had gasless abdomens, in which only stomach gas was visible. Oral contrast media (median, 2.5 mL) were administered at a median age of 7 days; five infants (5/7, 71.4%) responded to this treatment. The remaining two infants, who had ileal stenosis and hypoganglionosis, were surgically managed. Five infants (5/7, 71.4%) had maternal risk factors, and two (28.6%) were small for gestational age. @*Conclusion@#Nonionic oral water-soluble contrast medium can serve as a valuable adjunct treatment in premature infants with meconium obstruction.

17.
Article in English | WPRIM | ID: wpr-894310

ABSTRACT

Background@#Scabies is a parasitic infection caused by the Sarcoptes scabiei var. hominis mite. Its incidence has been increasing in recent years; however, no study has evaluated the clinical aspects of scabies in children and adolescents in Korea. @*Objective@#To evaluate the clinical characteristics and epidemiological features of scabies among children and adolescents and to investigate the clinical efficacy of topical therapies for the treatment of scabies. @*Methods@#We retrospectively reviewed the medical records of 62 patients under 18 years of age with scabies during a 10-year-period. @*Results@#Sixty-two patients with 62 scabies were investigated. These patients showed scabies mites or eggs under microscopic examination or showed clinical improvement after treatment. There were 36 boys (58.1%) and 26 girls (41.9%). The mean age of the boys was 9.3 years and that of the girls was 8.2 years. The most common primary lesions were erythematous papules (93.5%), and the commonest sites of the skin lesions were the hand (64.5%) and the trunk (61.3%). The most common suspected mode of transmission was through contact among families living together. The mean time to complete treatment was 46.1 days using 1% gamma benzene hexachloride lotion, 37.1 days using 10% crotamiton ointment, and 22.8 days using 5% permethrin cream. @*Conclusion@#We confirmed the epidemiological features and clinical characteristics of scabies in children and adolescents, including contact sources and treatment. This study could provide useful data for the prevention and management of scabies in children and adolescents.

18.
Article in English | WPRIM | ID: wpr-894279

ABSTRACT

Background@#Bacterial skin soft-tissue infection is a common clinical manifestation in dermatology. The treatment of bacterial skin infections is often challenging due to antibiotic resistance, including methicillin resistance. @*Objective@#The aim of this study was to investigate the isolation rate of bacteria, antibiotic susceptibility, clinical features, and factors associated with treatment response in bacterial skin infections. @*Methods@#We retrospectively reviewed the medical records of patients who underwent ordinary bacterial skin cultures of the site of superficial skin infections between 2010 and 2019. @*Results@#A total of 1,298 patients were included in the study. The most commonly isolated bacteria were Staphylococcus aureus (31.3%), followed by coagulase-negative staphylococci (22.0%) and Pseudomonas species (4.2%). The methicillin-resistance rate of S. aureus was 22.7%. Crusted lesions (p=0.025), treatment with steroids (p=0.035), duration over 7 days (p=0.009), and isolation of Pseudomonas (p<0.001) or other uncommon species (non-Staphylococcus, Streptococcus, and Pseudomonas species, p<0.001) were significantly associated with treatment response. @*Conclusion@#The methicillin-resistance rate of S. aureus was similar to that of the past 5 years, but the mupirocin-resistance rate significantly increased. Lesions with crust or those that were treated with steroids showed good treatment responses, but longer disease durations of over 7 days and skin infections caused by Pseudomonas or other uncommon species were poor prognostic factors that should receive more attention.

19.
Article in English | WPRIM | ID: wpr-894252

ABSTRACT

Eczema herpeticum is a widespread herpes simplex infection that favors eczema-damaged skin, including skin involved with atopic dermatitis. Here we report a case of a 27-year-old woman who presented with febrile, painful, punched-out, erosive, macular eruptions and crusts on her face, upper trunk, and antecubital fossae. Polymerase chain reaction analyses of the blood and skin lesions were positive for type 1 herpes simplex virus, and blood cultures established on admission showed methicillin-sensitive Staphylococcus aureus. She was diagnosed with bacteremia superimposed on eczema herpeticum. True bacteremia rather than contaminated blood cultures was suspected because her fever did not improve after 2 days despite the administration of antivirals. Repeated scratches to the lesional skin most likely aggravated the epidermal barrier damage, enabling the penetration of the dermal vessels by colonized S. aureus.

20.
Article in English | WPRIM | ID: wpr-894240

ABSTRACT

Atypical fibroxanthoma (AFX) is a rare fibrohistiocytic tumor usually observed on ultraviolet light-exposed areas of the body, such as the face or scalp in elderly individuals. Despite its clinically benign course, AFX presents with malignant features on histopathological evaluation. A 12-year-old male adolescent presented with a 3-month history of an asymptomatic, skin-colored, oval-shaped nodule on his right thigh. Histopathological examination showed a dermal tumor adjacent to the epidermis, without epidermal invasion. The tumor was composed of numerous pleomorphic spindle cells and large atypical histiocytes with abundant vacuolated cytoplasm and pleomorphic nuclei. Immunohistochemical analysis revealed tumor cells, which were immunopositive for vimentin, CD68, CD10 and immunonegative for desmin, pan-cytokeratin antibody (AE1/AE3), and S-100. Therefore, the patient was diagnosed with AFX. We report a rare case of AFX that occurred on the thigh (an unusual site) in an adolescent (an uncommon age group). Immunohistochemical analysis is important in patients with suspected AFX, regardless of the patient’s age and site of lesion, for accurate diagnosis to differentiate this condition from other diseases with a similar presentation.

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