Slower progression of central puberty in overweight girls presenting with precocious breast development

Purpose@#Overweight (OW)/obese girls tend to have an earlier pubertal onset than girls with normal weight. However, only a few studies have reported the progression of puberty in these girls. This study aimed to identify risk factors for rapid pubertal progression in OW/obese girls presenting with precocious breast development. @*Methods@#This retrospective cohort study reviewed the medical records of 110 OW (body mass index [BMI] ≥85th percentile for age and sex) and 213 nonoverweight (NW, BMI <85th percentile for age and sex) girls who presented with breast budding before 8 years of age. OW girls were divided into 2 subgroups: girls with central puberty progression before 9 years of age (OW-RP) and those without (OW-SP). @*Results@#Progression to central puberty before the age of 9 was more common in NW girls than in OW girls (83.8 % vs. 65.2 % in NW vs. OW group, p<0.001), and progression-free survival for 1, 2, and 3 years was higher in the OW group (p<0.001). In a subgroup analysis of OW girls, the OW-RP subgroup had more advanced bone age (BA) at the first visit (p=0.047) and higher initial luteinizing hormone (LH, p=0.010) levels than the OW-SP subgroup. Being NW (p=0.001) and having more advanced BA (p=0.023) at the initial workup were the risk factors for pubertal progression before age 9. @*Conclusion@#Pubertal progression seems to be slower in OW girls than in NW girls presenting with precocious breast development. However, it can progress rapidly in OW girls with particularly pronounced BA advancement and high LH levels at the initial workup.

Maternal Experiences of Anger While Raising a Child

Purpose@#This study aims to explore mothers’ experiences of anger while raising a child in South Korea based on a qualitative descriptive approach. @*Methods@#A total of ten mothers of children aged 1-3 years participated in the study. In-depth individual interviews were conducted from August to September 2019 to collect data, which were then subjected to thematic analysis. @*Results@#A total of 4 main themes and 10 subthemes were identified. The 4 themes were “individual and environmental factors that influence anger,” “a vicious cycle of anger expression and guilt,” “being a little bit more mature as a mother,” and “need for anger management.” This study described various causes, ways of expressing, and effects of anger, as well as the mother’s coping strategies. These experiences were viewed as milestones along the journey to becoming a real parent and helped mothers develop empathy for other children and mothers. The participants expressed support for expanding the social support system for child-rearing and providing psychological programs for mothers. @*Conclusion@#Mothers of children aged 1-3 years experienced anger owing to various factors, but adapted by developing coping skills. This study recommends family-based support interventions to help mothers manage their emotions and parenting roles.

Retrieval of Metallic Foreign Bodies from the Upper Airway Using Intraoperative C-Arm Fluoroscopy: Case Report and Literature Review / 대한이비인후과학회지

Foreign body ingestion is commonly encountered by otolaryngologists. Most foreign bodies in the upper airway can be easily removed via direct endoscopy; however, if they penetrate the soft tissue deeply, both localization and retrieval may be challenging. Here, we report on the successful removal of multiple sewing needles from the throat using intraoperative, real-time C-arm fluoroscopy to guide endoscopic extraction. The use of intraoperative, real time C-arm fluoroscopy to guide endoscopic extraction allowed quick, safe treatment and avoided any development of complications in our patient.

Medical Nutrition Therapy Using Carbohydrate Counting / 임상당뇨병

Improved postprandial glucose management requires careful monitoring of carbohydrate counting and consideration of the blood glucose response to dietary carbohydrate. Furthermore, learning how to use insulin-to-carbohydrate ratios for meal planning might help people successfully adjust insulin dose from meal to meal to enhance glycemic control. Regular education to raise knowledge of the link between carbohydrate intake and insulin requirements is critical for those whose meal schedules or carbohydrate consumption are unpredictable. Medical nutrition therapy is an important part of total diabetes management, and each person with diabetes should participate actively in education, self-management, and treatment planning with their health care team, including creation of a personalized food plan.

Factors Influencing Changes in Parenting Behavior during Coronavirus Disease 2019 Pandemic

Purpose@#This study aimed to examine the effects of maternal coronavirus disease 2019 (COVID-19) impact, parental stress, parenting behavior, and spousal support on changes in parenting behavior during the COVID-19 pandemic. @*Methods@#A total of 162 mothers who raised infants and toddlers under 24 months of age participated in this descriptive study via a web survey. The researchers collected data, which included demographic variables about mothers and babies, COVID-19 impact, parenting stress, spousal support, parenting behavior, and changes in parenting behavior after the pandemic. Data were analyzed using IBM SPSS Statistics ver. 24.0 using descriptive statistics, paired t-tests, analysis of variance, Pearson correlation, and multiple regression tests. @*Results@#With the spread of COVID-19, mothers with infants and toddlers appeared to be affected in the order of psychological burden, resources, and financial burden, and their parenting stress increased compared to that before the pandemic. The change in mothers’ parenting behaviors during the COVID-19 pandemic increased significantly as the mothers were significantly influenced by COVID-19. In addition, it was confirmed that the change in parenting behavior significantly decreased as mothers’ parenting stress increased. @*Conclusion@#Change in infants’ and toddlers’ mothers’ parenting behavior was associated with both COVID-19 impact and parenting stress in South Korea during the pandemic.

Comparison of Surgical Outcomes for Treatment of Maxillary Sinus Inverted Papilloma: Endoscopic Prelacrimal Recess Approach versus Caldwell-Luc Approach / 대한이비인후과학회지

Background and Objectives@#Endoscopic prelacrimal recess approach (PLRA) was introduced to treat maxillary sinus inverted papilloma (IP) without sacrificing the inferior turbinate and nasolacrimal duct. This study aimed to compare surgical outcomes of prelacrimal recess approach with the conventional Caldwell-Luc approach (CLA) to remove IP of maxillary sinus and to evaluate the usefulness of the PLRA.Subjects and Method We retrospectively reviewed medical records of 51 patients who were treated in our institution for IP of nasal cavity and sinuses between March 2010 and June 2019. Twenty patients had maxillary sinus IP. Sixteen patients underwent endoscopic sinus surgery combined with either CLA (n=8) or PLRA (n=8). Demographic data, surgical technique, site of IP origin, intra- and postoperative complications, duration of follow-up, recurrence rate and pathologic diagnosis were reviewed. @*Results@#IP was the pathologic diagnosis for all 16 cases. Gross total removal was achieved in all cases. The mean follow-up period was 20.1 months in CLA group and 12.5 months in PLRA group. There was one case of massive bleeding during operation requiring transfusion and postoperative ICU care in CLA group. On postoperative follow-up, two patients from the CLA group had recurrence during the follow-up period. One patient had numbness around the gingival area, another patient had transient wound dehiscence, and another had persistent oro-antral fistula. In PLRA group, one patient had periorbital swelling after blowing nose; otherwise, no other patient from the PLRA group developed subjective complaints after surgery. @*Conclusion@#Endoscopic prelacrimal recess approach showed lower complication rates and recurrence rates compared to CLA. PLRA is a safe and effective method for the excision of primary maxillary sinus IP.

Coxsackievirus A6-induced HandFoot-and-Mouth Disease Mimicking Stevens-Johnson Syndrome in an Immunocompetent Adult / 감염과화학요법

Hand-foot-and-mouth disease, a highly contagious viral infection, occurs more common in children than in adults. However, there was a recent outbreak of Coxsackievirus A6-induced infection with an atypical presentation among the adult population. Stevens– Johnson syndrome is a severe mucocutaneous disease characterized by extensive necrosis and detachment of the epidermis, and this condition is commonly caused by medications.Herein, we describe a 30-year-old male patient taking allopurinol for the management of gout. The patient presented with numerous erythematous papules, vesicles, and patches with mucosal eruptions on the whole body, oral mucositis, and fever, and he was finally diagnosed with hand-foot-and-mouth disease.

Coxsackievirus A6-induced HandFoot-and-Mouth Disease Mimicking Stevens-Johnson Syndrome in an Immunocompetent Adult / 감염과화학요법

Hand-foot-and-mouth disease, a highly contagious viral infection, occurs more common in children than in adults. However, there was a recent outbreak of Coxsackievirus A6-induced infection with an atypical presentation among the adult population. Stevens– Johnson syndrome is a severe mucocutaneous disease characterized by extensive necrosis and detachment of the epidermis, and this condition is commonly caused by medications.Herein, we describe a 30-year-old male patient taking allopurinol for the management of gout. The patient presented with numerous erythematous papules, vesicles, and patches with mucosal eruptions on the whole body, oral mucositis, and fever, and he was finally diagnosed with hand-foot-and-mouth disease.

The Effects of Operating Room Nurses' Perceptions of Organizational Health, Safety Climate, and the Nursing Working Environment on Engagement in Patient Safety Management Activities / 한국직업건강간호학회지

PURPOSE@#This study aimed to examine the relationship between organizational health (OH), safety climate (SC), the nursing working environment (NWE), and engagement in patient safety management activities (PSMA) among operating room nurses and identify the factors that predict engagement in PSMA.@*METHODS@#From August 10th to 25th, 2018, 176 operating room nurses who were working in tertiary and general hospitals responded to a structured questionnaire. Using SPSS/WIN 25.0, the collected data were subjected to independent-samples t-test, one-way analysis of variance, Scheffé test, and Pearson's correlational and multiple stepwise regression analyses.@*RESULTS@#OH and SC were significantly correlated with engagement in PSMA. The factors that predicted engagement in PSMA were OH, NWE, participation in accreditation, years of work experience, and hospital size; together, they explained 17% of the variance in engagement in PSMA.@*CONCLUSION@#This study revealed that OH has a significant influence on engagement in PSMA among operating room nurses. Therefore, hospitals should aim to create healthy working environments to promote engagement in PSMA among operating room nurses, actively delegate responsibilities to increase their level of participation in accreditation, and implement strategies that maintain high levels of nurse retention.

A Case of Transoral Endoscopic Thyroidectomy Combined with Facelift Modified Radical Neck Dissection / 대한이비인후과학회지

We recently experienced a case of transoral endoscopic thyroidectomy combined with a modified radical neck dissection (MRND) using a facelift approach in a patient with keloid-prone skin. A 35-year-old female was diagnosed with a papillary thyroid carcinoma, which was 1.2 cm in diameter and showed level II-III lateral cervical metastases. The patient required total thyroidectomy and MRND; however, she was concerned about the neck incision because she had keloid-prone skin. We first performed a transoral, endoscopic total thyroidectomy combined with bilateral central node dissection via a tri-vestibular approach, and then followed it by MRND (II-V) using a facelift approach with the Da Vinci robotic system. We noted no significant complications, such as vocal cord palsy, hypoparathyroidism, or permanent loss of the lower lip or auricle. This new method of combining transoral and facelift approaches will be useful for patients with small thyroid cancers and lateral neck metastases.

A Case of Transoral Endoscopic Thyroidectomy Combined with Facelift Modified Radical Neck Dissection / 대한이비인후과학회지

We recently experienced a case of transoral endoscopic thyroidectomy combined with a modified radical neck dissection (MRND) using a facelift approach in a patient with keloid-prone skin. A 35-year-old female was diagnosed with a papillary thyroid carcinoma, which was 1.2 cm in diameter and showed level II-III lateral cervical metastases. The patient required total thyroidectomy and MRND; however, she was concerned about the neck incision because she had keloid-prone skin. We first performed a transoral, endoscopic total thyroidectomy combined with bilateral central node dissection via a tri-vestibular approach, and then followed it by MRND (II-V) using a facelift approach with the Da Vinci robotic system. We noted no significant complications, such as vocal cord palsy, hypoparathyroidism, or permanent loss of the lower lip or auricle. This new method of combining transoral and facelift approaches will be useful for patients with small thyroid cancers and lateral neck metastases.

The Effects of Operating Room Nurses' Perceptions of Organizational Health, Safety Climate, and the Nursing Working Environment on Engagement in Patient Safety Management Activities / 산업간호학회지

PURPOSE: This study aimed to examine the relationship between organizational health (OH), safety climate (SC), the nursing working environment (NWE), and engagement in patient safety management activities (PSMA) among operating room nurses and identify the factors that predict engagement in PSMA.METHODS: From August 10th to 25th, 2018, 176 operating room nurses who were working in tertiary and general hospitals responded to a structured questionnaire. Using SPSS/WIN 25.0, the collected data were subjected to independent-samples t-test, one-way analysis of variance, Scheffé test, and Pearson's correlational and multiple stepwise regression analyses.RESULTS: OH and SC were significantly correlated with engagement in PSMA. The factors that predicted engagement in PSMA were OH, NWE, participation in accreditation, years of work experience, and hospital size; together, they explained 17% of the variance in engagement in PSMA.CONCLUSION: This study revealed that OH has a significant influence on engagement in PSMA among operating room nurses. Therefore, hospitals should aim to create healthy working environments to promote engagement in PSMA among operating room nurses, actively delegate responsibilities to increase their level of participation in accreditation, and implement strategies that maintain high levels of nurse retention.

Knowledge, Confidence, and Learning Needs Regarding Advance Directives among Hospital Nurses / 중환자간호학회지

PURPOSE: Nurses' knowledge regarding advance directives may affect their administration of and confidence towards end of life care. This study aimed to describe the relationships of knowledge, confidence, and learning needs with advance directives among hospital nurses.METHOD: This cross-sectional study was performed at a tertiary university hospital in Seoul between September 25 and October 14, 2017. Convenience sampling was used to recruit nurses who provided bedside care and had at least 1 year of clinical experience. We used a validated self-report questionnaire.RESULTS: The mean score of knowledge, confidence and learning needs were 5.00±1.73, 29.81±7.52, and 64.54±8.48 respectively. Hospital nurses' knowledge, confidence and learning needs were significantly different according to age, job position, educational level and perceived advance directives. Knowledge regarding advance directives was significantly associated with confidence (r = .27, p < .001) and learning needs (r = .16, p = .005).CONCLUSION: Knowledge regarding advance directives was relatively low compared to the findings of previous studies. Therefore, nurses should be knowledgeable and encouraged to initiate advance directives. It is necessary to develop a standardized educational program regarding advance directives based on Korean cultures.

A Case of Hamartoma of the Subglottis / 대한이비인후과학회지

Hamartoma is a developmental anomaly or non-neoplastic malformations composed by an excessive growth of indigenous mature tissue present in wrong proportions and abnormal arrangements. Hamartomas may develop in all areas of the body but it is extremely rare in the larynx. The treatment of hamartomas consists of adequate surgical excision leading to an excellent prognosis. We present an incidentally detected subglottic mass during intubation in a 70-year-old male patient. The mass was excised by transoral laser surgery. Histopathologic examination of the lesion revealed that it consisted of hamartoma.

Varicella Zoster Virus Infection of the Pharynx and Larynx without Vocal Cord Palsy / 대한이비인후과학회지

Varicella zoster virus (VZV) infection in the head and neck may manifest as various clinical symptoms and signs which depend on the combination of involved multiple cranial nerves. Involvements of cranial nerve IX and X by VZV are very rare compared to cranial nerve V, VII, and VIII. We present a case of VZV infection of multiple mucosal erosions in the pharynx and larynx, which was confined to the left side without any associated motor dysfunction. VZV infection was confirmed by polymerase chain reaction on the eruptional mucosal lesions and blood. The patient was treated with an antiviral agent, leading to a complete recovery of multiple mucosal lesions after 2 weeks without any sequela.

Evidence-Based Clinical Practice Guideline for Fluid Therapy to Prevent Contrast-induced Nephropathy / 임상간호연구

PURPOSE: This study was to develop evidence-based clinical practice guideline in order to prevent contrast-induced nephropathy (CIN) for patients undergoing percutaneous coronary intervention (PCI). METHODS: The guideline was developed based on the “Scottish Intercollegiate Guidelines Network (SIGN)”. The first draft of guideline was developed through 5 stages and evaluated by 10 experts.(1) Clinical questions were ensured in PICO format.(2) Two researchers conducted a systematic search through electronic database, identifying 170 studies. We selected 27 full text articles including 16 randomized clinical trials, 7 systematic reviews, and 4 guidelines. Quality of each studies were evaluated by the Cochran's Risk of Bias, AMSTAR, K-AGREEII. Among the studies, 11 studies were excluded.(3) The strength of recommendations were classified and quality of recommendations were ranked.(4) Guideline draft was finalized.(5) Content-validation was conducted by an expert group. All contents were ranked above 0.8 in CVI. RESULTS: Evidence-based clinical practice guideline to prevent CIN was dveloped.(1) The guideline for preventing CIN recommends using 0.9% saline.(2) Standardized rate of fluid therapy is 1 to 1.5ml/kg/hr.(3) Execute hydration for 6~12hrs before PCI and after PCI. CONCLUSION: This study suggests evidence-based clinical practice guideline for preventing CIN which can be more efficiently used in clinical practice.

Erratum to: Incidental Findings of Intense Radioiodine Uptake in Struma Ovarii and Bilateral Non-Lactating Breast Simultaneously on Post-Ablation SPECT/CT for Papillary Thyroid Cancer / 대한핵의학회잡지

Although the corresponding author of article is Mi Ra Kim, the name and e-mail address of the first author, Hye-kyung Shim were incorrectly given instead.

A Case of Fish Bone-Induced Submandibular Gland Stone / 대한이비인후과학회지

Sialolithiasis is the most common disorder associatd with major salivary glands. It may form in any salivary glands or ducts, but is reported to occur more often in the submandibular gland than in the parotid or sublingual gland. Although the pathogenesis is not perfectly revealed, there appear to be several factors that predispose the submandibular gland duct to be a common site of sialolithiasis. Sialolithiasis occurs as a consequence of the precipitation of calcium salts around a central nidus of desquamated epithelial cells, inflammatory cells, mucoid gels or foreign body. However, it is not a common thing that foreign body entered into the salivary duct through duct orifice may act as the initiating factor. We have recently experienced a case in a 52-year-old female, in which sialolithiasis seems to have formed due to a a foreign body, a fish bone, in the right submandibular gland duct.

A Case of Pneumorrhachis Associated with Spontaneous Pneumomediastinum and Subcutaneous Emphysema / 대한이비인후과학회지

Pneumorrhachis or epidural emphysema is an uncommon finding observed in the spinal epidural space. Pneumorrhachis could be occasionally associated with pneumomediastinum or pneumothorax or subcutaneous emphysema. Probably this results from air that leaks from the mediastinum, which traverses through the fascial planes and intervertebral neural foramina. In particular, without any causes, these conditions rarely appear simultaneously with trauma, surgery, malignancy, anesthesiological interventions, or Valsalva maneuvers. We report a case of pneumorrhachis accompanied by spontaneous pneumomediastinum and subcutaneous emphysema that was resolved after conservative treatment.

Transoral endoscopic thyroidectomy via the trivestibular route

We recently experienced a case of transoral endoscopic thyroidectomy via the trivestibular approach. We identified and preserved all neighboring critical structures during surgery. The patient was discharged on postoperative day 3. There were no complications in thyroid function, vocal cord function, or lower lip sense. Transoral endoscopic thyroidectomy via a trivestibular approach provides a short and direct route to the thyroid and an adequate workspace without a skin incision. Therefore, it is worthwhile to develop and refine the surgical techniques of this promising new surgical approach.