A study on the effect of system construction including emergency medical service center manual on patient’s satisfaction with emergency medical service / 의료커뮤니케이션

Background@#: The purpose of this study was to determine the effect of emergency medical service system development including service and process manual on patients satisfaction with emergency medical service. @*Methods@#: This study used simulated control group pre-posttest design and included 322 of pre- and 227 of post-construction for system in emergency centers (EC) of university hospitals located in Daegu. Data were collected with a self-administered questionnaire for one month pre-post construction for the system. Construction for the system included development of emergency medical center manual, computerization of EC patient-bed number, compartmentalization and assignment of Nurse System in the EC, providing education for compassion care for all EC staff, improving direction signs for the department of administration, and emergency pharmacies. Data analysis was conducted using descriptive statistics. @*Results@#: There was a statistically significant difference in nurse kindness between the experimental group of 12.38 and the control group of 11.82 (p = .011). Satisfaction was also improved in the facility environment, work procedures, doctor friendliness, medical technology and costs, including overall satisfaction, and waiting time was slightly higher in the experimental group (10.92±1.87) than the control group (10.76±2.03), but there were no statistically significant differences. @*Conclusion@#: The result of this study was statistically significant only in the nurse kindness. While the difference was not statistically significant, the experimental group showed improved satisfaction in all areas except latency. This resulted in a limitation in testing the effectiveness of the emergency medical center system because the waiting time was higher in the experimental group due to the strike and construction going on at two nearby university hospitals. Therefore, since waiting time is an important factor in the satisfaction of EC service, interventional studies are needed to reduce waiting time.

Radiocontrast media-induced acute generalized exanthematous pustulosis: A safe administration of alternative radiocontrast media using patch tests

Acute generalized exanthematous pustulosis (AGEP) is rarely caused by radiocontrast media (RCM). The role of skin tests for the diagnosis and evaluation of cross-reactivity in a delayed type of RCM-induced hypersensitivity have yet to be determined. Here, we report a case of iodixanol-induced AGEP where we safely administered alternative RCM using patch tests. A 44-year-old woman had coronary artery angiography (CAG) for the evaluation of ischemic heart disease. She was on regular hemodialysis because of end-stage renal disease. She was given iodixanol (Visipaque) during CAG. Approximately 1 day after CAG, she developed AGEP. The patient was rehospitalized for CAG again after 1 year. We performed skin tests to choose safe alternative RCM. Intradermal tests with iodixanol, iohexol (Bonorex) and Iopamidol (Pamiray) showed negative responses. Patch tests showed a positive response to iodixanol, equivocal to iohexol, and negative to Iopamidol. We finally chose Iopamidol and performed CAG successfully without any adverse reaction. Patch tests may be a useful tool for the diagnosis and choice of safe alternatives in RCM-induced delayed-type hypersensitivity reactions such as AGEP.

Ischemic Gastritis Improved by Supportive Care

Acute extensive ischemic gastritis is an extremely rare disease because the stomach has an abundant submucosal vascular plexus with a dual blood supply from the pancreaticoduodenal and gastroduodenal arteries. Smoking, hypertension, and atherosclerotic vascular diseases can be major risk factors for ischemic gastritis. Acute gastric ischemia presents as an acute abdomen with diarrhea or hematemesis that rapidly progresses to acute peritonitis, irreversible septic shock, and death if untreated. We report a case of acute extensive ischemic gastritis combined with tetraplegia due to cervical myelopathy and extensive atherosclerotic changes of the celiac trunk and abdominal aorta.

Molecular Testing for Gastrointestinal Cancer

With recent advances in molecular diagnostic methods and targeted cancer therapies, several molecular tests have been recommended for gastric cancer (GC) and colorectal cancer (CRC). Microsatellite instability analysis of gastrointestinal cancers is performed to screen for Lynch syndrome, predict favorable prognosis, and screen patients for immunotherapy. The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor has been approved in metastatic CRCs with wildtype RAS (KRAS and NRAS exon 2–4). A BRAF mutation is required for predicting poor prognosis. Additionally, amplification of human epidermal growth factor receptor 2 (HER2) and MET is also associated with resistance to EGFR inhibitor in metastatic CRC patients. The BRAF V600E mutation is found in sporadic microsatellite unstable CRCs, and thus is helpful for ruling out Lynch syndrome. In addition, the KRAS mutation is a prognostic biomarker and the PIK3CA mutation is a molecular biomarker predicting response to phosphoinositide 3-kinase/AKT/mammalian target of rapamycin inhibitors and response to aspirin therapy in CRC patients. Additionally, HER2 testing should be performed in all recurrent or metastatic GCs. If the results of HER2 immunohistochemistry are equivocal, HER2 silver or fluorescence in situ hybridization testing are essential for confirmative determination of HER2 status. Epstein-Barr virus–positive GCs have distinct characteristics, including heavy lymphoid stroma, hypermethylation phenotype, and high expression of immune modulators. Recent advances in next-generation sequencing technologies enable us to examine various genetic alterations using a single test. Pathologists play a crucial role in ensuring reliable molecular testing and they should also take an integral role between molecular laboratories and clinicians.

Parosteal Lipoma in the Metatarsus: A Case Report / 대한족부족관절학회지

We experienced a rare case of parosteal lipoma, which located on the periosteum of the foot 4th metatarsus. A 22-year-old woman visited the hospital with painful mass in her foot. Based on the assessment of plain radiographs, computed tomography scan, and magnetic resonance image, it was suspected as lipoma. Marginal excision was performed and parosteal lipoma was confirmed histologically. Any local recurrence and complications were not observed in 2 years after surgery.

Hypereosinophilic Syndrome Presenting as Eosinophilic Cholangiopathy and Cystitis / 대한췌담도학회지

Eosinophilic cholangiopathy is a rare disease characterized by dense transmural eosinophilic infiltration of the gallbladder and bile duct. It's clinical and laboratory manifestations are not different from those of other causes of cholangiopathy, and the diagnosis is usually made based on pathologic findings after cholecystectomy. Moreover, the occurrence of eosinophilic cystitis accompanied by cholangiopathy is extremely rare. We report a rare case of hypereosinophilic syndrome manifested as eosinophilic cholangiopathy accompanied with eosinophilic cystitis, for the first time in Korea, in a 49-year-old woman who presented with persistent right upper quadrant pain. After performing imaging study to validate the diagnosis of acute acalculous cholecystitis and cholangitis, an urgent cholecystectomy was performed. Pathologic examination of the excised gallbladder was consistent with eosinophilic cholecystitis. The patient underwent bladder biopsy because there was persistant irritative voiding symptoms combined with constant mild peripheral eosinophilia even after cholecystectomy, and the pathologic findings revealed eosinophilic cystitis. Symptoms and peripheral eosinophilia were improved after steroid therapy for an indicated period.

Acquired Dermal Melanocytosis of the Dorsum in a Middle-Aged Asian Woman

No abstract available.

Reliability and Validity of the Korean Young Schema Questionnaire-Short Form-3 in Medical Students

OBJECTIVE: The Young Schema Questionnaire (YSQ) is a self-report measure of early maladaptive schemas and is currently in its third revision; it is available in both long (YSQ-L3) and short (YSQ-S3) forms. The goal of this study was to develop a Korean version of the YSQ-S3 and establish its psychometric properties in a Korean sample. METHODS: A total of 542 graduate medical students completed the Korean version of the YSQ-S3 and several other psychological scales. A subsample of 308 subjects completed the Korean YSQ-S3 both before and after a 2-year test-retest interval. Correlation, regression, and confirmatory factor analyses were performed on the data. RESULTS: The internal consistency of the 90-item Korean YSQ-S3 was 0.97 and that of each schema was acceptable, with Cronbach's alphas ranging from 0.59 to 0.90. The test-retest reliability ranged from 0.46 to 0.65. Every schema showed robust positive correlations with most psychological measures. The confirmatory factor analysis for the 18-factor structure originally proposed by Young, Klosko, and Weishaar (2003) showed that most goodness-of-fit statistics were indicative of a satisfactory fit. CONCLUSION: These findings support the reliability and validity of the Korean version of the YSQ-S3.

Clinical and Histological Correlation in Post-Burn Hypertrophic Scar for Pain and Itching Sensation

BACKGROUND: Hypertrophic scar following a burn is caused by the excessive deposit of collagen resulting in an exaggerated wound healing response. The burn patient complains of pain and itching over the scar, which can give rise to cosmetic and functional problems. OBJECTIVE: The aim of this study was to investigate the clinical and histological correlation of a hypertrophic burn scar for itching and pain sensations. METHODS: Thirty-eight patients underwent a scar release and skin graft. the modified Vancouver scar scale and the verbal numerical rating scale were recorded. All biopsies were taken from scar tissue (scar) and normal tissue (normal). Histologically, tissues were observed in the epidermis, the monocytes around the vessels, the collagen fiber, elastic fiber, and the mast cells. RESULTS: The mean total score of MVSS was 8.4+/-2.7 (pliability 2.0+/-0.9; thickness 1.8+/-0.9; vascularity 2.0+/- 0.9; and pigmentation 2.1+/-0.9). Pain and itching were 2.4+/-2.0 and 2.9+/-3.0. Epidermis were 7.9+/-2.8 layers (scar) and 4.0+/-0.8 layers (normal). The collagen fibers were thin and dense (scar) and thicker and loose (normal). The elastic fibers were thin and nonexistent (scar) and thin and loose (normal). Mast cells were 11.2+/-5.8/high power field (scar) and 7.4+/-4.1 (normal). CONCLUSION: As the scar tissue thickens, the itching becomes more severe. The stiffness of the scar with the pain appeared to be associated with the condition of the tissue. The correlation between clinical and histological post-burn hypertrophic scars will help further studies on the scar. This helped with the development of the base material for therapeutic strategies.

A Case of Multiple Myeloma with Brain Parenchyme Involvement

Multiple myelomas (MM) are characterized by monoclonal proliferation of immunoglobulin (Ig)-secreting plasma cells. Central nervous system involvement is a rare complication of MM, and it can present as either an intraparenchymal or a leptomeningeal lesion. A 77-year-old woman was transferred from the dementia clinic in July 2012. She had a large heterogeneous signal mass with central necrosis and with pial involvement in the left frontal lobe with destruction of the frontal bone that was observed on computed tomography and magnetic resonance imaging. Multiple punched out radiolucent lesions were also noted on the skull X-ray. Serum protein electrophoresis revealed an IgA-kappa monoclonal gammopathy. External lumbar drainage was helpful for treating the fluid collection underneath the scalp after an orbitozygomatic craniotomy with duroplasty.

Development and Validation of a Liquid Chromatography-Tandem Mass Spectrometry Method for the Determination of epsilon-Acetamidocaproic Acid in Rat Plasma

A simple and rapid liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed and validated for the quantification of epsilon-acetamidocaproic acid (AACA), the primary metabolite of zinc acexamate (ZAC), in rat plasma by using normetanephrine as an internal standard. Sample preparation involved protein precipitation using methanol. Separation was achieved on a Gemini-NX C18 column (150 mm x 2.0 mm, i.d., 3 microm particle size) using a mixture of 0.1% formic acid-water : acetonitrile (80 : 20, v/v) as the mobile phase at a flow rate of 200 microl/min. Quantification was performed on a triple quadrupole mass spectrometer employing electrospray ionization and operating in multiple reaction monitoring (MRM) and positive ion mode. The total chromatographic run time was 4.0 min, and the calibration curves of AACA were linear over the concentration range of 20~5000 ng/ml in rat plasma. The coefficient of variation and relative error at four QC levels were ranged from 1.0% to 5.8% and from -8.4% to 6.6%, respectively. The present method was successfully applied for estimating the pharmacokinetic parameters of AACA following intravenous or oral administration of ZAC to rats.

Ruptured Heterotopic Tubal Pregnancy for a Patient with a History of Segmental Salpingectomy from Ectopic Pregnancy: A Case Report

Heterotopic pregnancy refers to the simultaneous development of an intrauterine pregnancy and an extrauterine pregnancy. We experienced a case of a ruptured heterotopic pregnancy for a patient with a history of a right segmental salpingectomy from an ectopic pregnancy. The 30-year-old patient with amenorrhea for six weeks complained of lower abdominal pain with hypovolemic shock. Transabdominal ultrasonography showed diffuse hemoperitoneum with a structure similar to an ectatic tube or a deformed cyst with no echogenic double ring or peripheral hypervascularity in the right adnexa and an intrauterine gestational sac. We considered a ruptured corpus luteum cyst as an ultrasonographic finding and found a ruptured tubal mass in the right salpinx and hemoperitoneum through an emergency laparotomy. We performed a right salpingectomy, and the histopathologic report confirmed ectopic pregnancy.

Fiber-optic Bronchoscopic Classification of Inhalation Injury: Is That Consistent with Pathologic Findings?

PURPOSE: Fiber-optic bronchoscopy is widely used for early diagnosis of inhalation injury. The aim of the study was to ascertain whether a correlation could be shown between bronchoscopic and pathologic grading. METHODS: One hundred seventy patients who underwent bronchoscopy with suspicious inhalation injury were review retrospectively from January 2008 to December 2009. The patients were divided into four groups (normal, mild, moderate, severe) according to bronchoscopic and pathologic findings respectively. RESULTS: Diagnosis of an inhalation burn was confirmed in 142/170 patients, of whom upon initial assessment an inhalation trauma was suspected. Bronchoscopic grading was noted: mild (n=109), 56 ALI (51.4%), 18 ARDS (16.5%); moderate (n=31), 22 ALI (71.0%), 13 ARDS (41.9%); severe (n=2), 2 ALI (100%). Pathologic grading was noted: mild (n=131), 77 ALI (58.8%), 27 ARDS (20.6%); moderate (n=4), 2 ALI (50%), 1 ARDS (25%); severe (n=1), 1 ALI (100%). Consistency of two groups was not significant (P<0.05). CONCLUSION: Any burn patient highly suspicious for inhalation injury should receive an early bronchoscopy for diagnosis and treatment. Fiber-optic bronchoscopy is a safe and effective method for early diagnosis of inhalation injuries. The consensus of classification about inhalation injury will be developed.

Current Trends in the Epidemiological and Pathological Characteristics of Gastrointestinal Stromal Tumors in Korea, 2003-2004

Despite remarkable progress in understanding and treating gastrointestinal stromal tumors (GISTs) during the past two decades, the pathological characteristics of GISTs have not been made clear yet. Furthermore, concrete diagnostic criteria of malignant GISTs are still uncertain. We collected pathology reports of 1,227 GISTs from 38 hospitals in Korea between 2003 and 2004 and evaluated the efficacy of the NIH and AFIP classification schemes as well as the prognostic factors among pathologic findings. The incidence of GISTs in Korea is about 1.6 to 2.2 patients per 100,000. Extra-gastrointestinal GISTs (10.1%) are more common in Korea than in Western countries. In univariate analysis, gender, age, tumor location, size, mitosis, tumor necrosis, vascular and mucosal invasions, histologic type, CD34 and s-100 protein expression, and classifications by the NIH and AFIP criteria were found to be significantly correlated with patient's survival. However, the primary tumor location, stage and classification of the AFIP criteria were prognostically significant in predicting patient's survival in multivariate analysis. The GIST classification based on original tumor location, size, and mitosis is more efficient than the NIH criteria in predicting patient's survival, but the mechanism still needs to be clarified through future studies.

Clinical Analysis of Inguinal Hernia in Adult Using Prolene Hernia System

PURPOSE: The aim of this study was to detail clinical experiences with a type of tension-free herniorrhaphy using the prolene hernia system (PHS) and analyze the system's usefulness. METHODS: We retrospectively reviewed the medical records of 122 patients who underwent an inguinal hernia repair using PHS between March 2004 and August 2008. RESULTS: There were 116 male and 6 female patients ages 14 to 99; 79 indirect, 33 direct, 10 pantaloon hernias. The right inguinal hernias were more frequent (64.7%). The mean operative time for inguinal hernia repair using PHS was 45.2+/-1.5 minutes and the mean postoperative hospital stay was 3.5+/-1.5 days (101+/-82.9 hours). The most frequent combined disease was hypertension. The most frequent complication of PHS repair was hematoma. The mean number of used analgesics was 3.1+/-3.3. There were no postoperative recurrences. CONCLUSION: Tension-free herniorrhaphy using PHS is thought to be a useful method of inguinal hernia repair in adults because it offers lower postoperative pain, shorter operation time and shorter postoperative hospital stay.

Gastric Polyposis Associated with Gastric Cancer

Gastric polyps encompass a wide variety of lesions that most commonly arise from the gastric epithelium. However, coincidental gastric carcinomas have rarely been reported, being found in only 2~3% of patients with hyperplastic polyps. A 68-year-old male was admitted to our hospital for bleeding control of a gastric polyp. The gastroscopy shows numerous polyps in the entire gastric mucosa and a huge ulcer with bleeding. The bleeding of the gastric ulcer could not be controlled by gastroscopic procedures. So, we performed total gastrectomy for bleeding control. The pathologic findings shows poorly differentiated adenocarcinoma with hyperplastic polyps. We performed treatment with Cisplatin and 5-FU for two cycles. Two months postoperative, he was admitted due to dyspnea associated with ascites. We performed a ckeckup by computer tomography. It revealed cancer recurrence with lymphatic and liver metastasis, and diffuse massive ascites with mesenteric cake, and it suggested cancer peritonei.

Immunohistochemical Expression of Stem Cell Markers during the Wound Healing Process of Cutaneous Burn

PURPOSE: A cutaneous wound healing requires a well-orchestrated integration of the complex biological and molecular events of cell migration and proliferation, extracellular matrix deposition, angiogenesis and remodeling. Finally, skin regeneration is the main goal. Stem cells are self-renewing multipotent progenitors with the broadest developmental potential in a given tissue at a given time. The aim of this study was to examine the role of stem cells during the wound healing process of cutaneous burn in hairless mice by using immunohistochemical stainings (nestin, cytokeratin 15 and CD31). METHODS: Each mouse received 2 burns at the dorsal area by applying a metal stick heated in boiling water. Burn wound sites were dressed with duoderm. The mice were sacrificed at 0, 2, 7, 14 and 21 days after burn. Histological findings and immunohistochemical expression for stem cell markers were observed. RESULTS: Nestin was expressed in the stromal cells beneath the epidermis, hair follices, dermal cysts and endothelial cells. Cytokeratin 15 was expressed in the epidermis except in basal cells. On 7 and 14 days after burn, the regenerated epidermis didn't express cytokeratin 15. CD31 was expressed in the endothelial cells on 7 and 14 days after burn. The amount of nestin expression was the highest. CONCLUSION: Our results showed that nestin may have various effects on burn wound healing. Cytokeratin 15 was expressed before burn and after burn. It is likely that other cytokeratin may stimulate epithelial regeneration. CD31 may act in vascular regeneration during burn healing.

Calcium Polystyrene Sulfonate Induced Colonic Necrosis in Patient with Chronic Kidney Disease / 대한소화기학회지

A 63-year-old woman was admitted due to right upper quadrant abdominal pain. She was going through hemodialysis due to end stage renal disease and taking calcium polystyrene sulfonate orally and rectally due to hyperkalemia. Colonoscopy showed a circular ulcerative mass on the proximal ascending colon. Biopsy specimen from the mass showed inflammation and necrotic debris. It also revealed basophilic angulated crystals which were adherent to the ulcer bed and normal mucosa. These crystals were morphologically consistent with calcium polystyrene sulfonate. She was diagnosed with calcium polystyrene phosphate induced colonic necrosis and improved with conservative treatment.

Laparoscopic versus Open Appendectomy for Complicated Appendicitis / 대한내시경복강경외과학회지

PURPOSE: The value of laparoscopic appendectomy for complicated appendicitis is still controversial. The purpose of this clinical study was to evaluate the efficacy of laparoscopic appendectomy in patients with complicated appendicitis. METHODS: This study involved a total of 108 consecutive patients who had undergone appendectomy for complicated appendicitis between January 2008 and August 2009. Those patients were divided into two groups; laparoscopic appendectomy (LA) and open appendectomy (OA). The demographic data, the incidence of drainage tube insertion, the operative time, the duration of pain, the time to a soft oral diet, the hospital days and the complication rate for the two groups were analyzed. RESULTS: There were no significant differences of the operative time (OA group: 65.2+/-27.31 min vs the LA group: 64.6+/-23.6 min) (p=0.233). However, in the LA group, there were benefits for number of drainage tube insertions (OA group: 48/60 vs the LA group: 8/48) (p<0.001), the use of analgesics (OA group: 3.2+/-3.9 times vs the LA group: 1.4+/-1.3 times) (p<0.001), the time to start a soft diet (OA group: 2.8+/-1.3 days vs the LA group: 1.4+/-1.3 days) (p=0.020), the hospital stay (OA group 7.5+/-3.4 days vs LA group 3.7+/-2.2 days) (p=0.040) and the complication rate (OA group: 18/60 vs the LA group: 8/48) (p<0.001). CONCLUSION: These results suggest that laparoscopic appendectomy for treating complicated appendicitis is a safe procedure that may prove to have significant clinical advantages over open appendectomy.

Aloe-induced Toxic Hepatitis

Aloe has been widely used in phytomedicine. Phytomedicine describes aloe as a herb which has anti-inflammatory, anti-proliferative, anti-aging effects. In recent years several cases of aloe-induced hepatotoxicity were reported. But its pharmacokinetics and toxicity are poorly described in the literature. Here we report three cases with aloe-induced toxic hepatitis. A 57-yr-old woman, a 62-yr-old woman and a 55-yr-old woman were admitted to the hospital for acute hepatitis. They had taken aloe preparation for months. Their clinical manifestation, laboratory findings and histologic findings met diagnostic criteria (RUCAM scale) of toxic hepatitis. Upon discontinuation of the oral aloe preparations, liver enzymes returned to normal level. Aloe should be considered as a causative agent in hepatotoxicity.