A Collision Tumor of the Esophagus: Mixed Squamous Cell Carcinoma and Neuroendocrine Carcinoma / 대한소화기학회지

Collision tumors are extremely rare, and currently, no therapeutic protocols are established. A 64-year-old man presented to his physician with complaints of right chest and abdominal pain. The contrast-enhanced CT scan showed a mass measuring 3.6 cm around the gastric fundus. Esophagogastroduodenoscopy was performed and a semicircular longitudinal ulcerative mass was found at the distal esophagus. A mass measuring about 4 cm with central ulceration was noted at the cardia. The esophageal biopsy revealed positivity for a component of neuroendocrine carcinoma adjacent to a squamous cell carcinoma. PET-CT revealed a mass in the esophagus and cardia and several tumors in the whole liver, pancreas, and bone. The patient was finally diagnosed with a collision tumor of the esophagus with multiple metastases. In conclusion, patients with collision tumors must undergo active multidisciplinary management that will include pathologists and oncologists, who will decide on proper treatment strategies.

Gender Specific Differences in Prevalence and Risk Factors for Gastro-Esophageal Reflux Disease

BACKGROUND: Gender-related factors might play an important role in the development of reflux esophagitis (RE) and symptomatic gastro-esophageal reflux disease (GERD). We aimed to evaluate the prevalence and risk factors for RE and symptomatic GERD and determine whether gender specific differences exist. METHODS: This study was conducted on a health cohort consisting of 10,158 participants who underwent comprehensive health screening. Lifestyles and gastrointestinal symptoms were investigated using a self-reported structured questionnaire. Questionnaires about menstrual status were added for the women. RESULTS: The prevalence of RE in men was significantly higher than that in women (10.6% vs. 2.0%, P < 0.001); however, symptomatic GERD showed predominance in women (6.2% vs. 2.5%, P < 0.001). Although the prevalence of RE gradually increased with the duration of menopause stratified by decade (P = 0.007), that of symptomatic GERD rapidly increased across the menopausal transit in women. Apart from common risk factors of obesity and current smoking for RE, over 70 years of age in women and hiatal hernia and hypertriglyceridemia in men were significant risk factors. In symptomatic GERD, high somatization was a common risk factor. Excessive alcohol drinking was a significant risk factor in men, but not in women. CONCLUSION: This study showed a predominance of RE in men, but a predominance of symptomatic GERD in women. In women, dynamic increase in the prevalence of GERD is closely related to the menopause conditions and its duration. There are specific risk factors for RE and symptomatic GERD according to gender differences.

Risk Factors for Metachronous Recurrence after Endoscopic Submucosal Dissection of a Gastric Neoplasm

BACKGROUND/AIMS: Although endoscopic submucosal dissection (ESD) is an accepted treatment method for gastric neoplasm worldwide, metachronous recurrence often occurs. Here, we evaluated the risk factors for metachronous recurrence after ESD of gastric dysplasia or adenocarcinoma and also examined the effects of Helicobacter pylori (H. pylori) eradication. MATERIALS AND METHODS: Among 400 patients who underwent endoscopic resection from February 2005 to December 2014 at Ewha Womans University Hospital, the medical records of 180 patients were retrospectively reviewed. RESULTS: The enrolled patients included 118 men and 62 women, and their median age was 61.7±10.3 years. During a median follow-up period of 34.5 months, metachronous recurrence occurred in 21 (11.7%) patients. Multivariate analyses revealed that H. pylori eradication did not have any preventive effects on metachronous recurrence. A family history of gastric cancer was the only risk factor for metachronous recurrence after ESD of the gastric neoplasm. CONCLUSIONS: Metachronous recurrence was found to be related to family history of gastric cancer. However, H. pylori eradication had no preventive effects on metachronous recurrence after ESD of a gastric neoplasm. Therefore, intensive surveillance is required for patients who undergo ESD of a gastric neoplasm and have a family history of gastric cancer.

A Historical Trends of Doctoral Nursing Education in Korea / 한국간호교육학회지

PURPOSE: The aim of this study was to identify historical backdrop leading to the introduction of the doctorate degree of nursing in Korea, and to explore trends of doctoral nursing education program. METHODS: The research design was a descriptive study adopting a historical approach. Documentation data were collected through web sites and mail survey. The semi-structured interviews were conducted with 6 professors who were involved in the introduction of the doctorate degree of nursing. The outcomes of doctoral nursing education program were evaluated with a total of 1,153 dissertations' titles published from 1982 to 2007. RESULTS: First introduced in Korea in 1978, doctoral nursing education program had steadily increased totaling 21 doctoral program in 2007. This resulted in a rapid increase in the number of doctoral students, but the number of faculty and the quality were not as satisfactory as expected. Many doctoral program had the missions or goals that fostered nursing scholars, theorists, and researchers, a trend that seems set to continue. The majority of dissertations utilized the experimental design (39.9%), others were qualitative design (21.6%), and survey design (19.0%). CONCLUSION: Doctoral education that is the hallmark of nursing scholarship is further elaborated in terms of academic tradition of nursing school in Korea.

Development and Evaluation of a Video Discharge Education Program focusing on Mother-infant Interaction for Mothers of Premature Infants

PURPOSE: This study was done to develop a video discharge education program focusing on mother-infant interaction to facilitate the development of maternal role confidence for mothers of premature infants. METHODS: The process of the program was based on the Network-based Instructional System Design suggested by Jung (1999). For the content of the program, needs and concerns of mothers of premature infants found on web sites and existing literature were analyzed. Based on this content, the scenario and the video were developed. Nurses and mothers of premature infants participated in the process of testing the content validity, scenario development, and evaluation of final video production. The final video has two parts and lasts 21 minutes. The first part focuses on mother-premature infant interaction and the second part focuses on health management of infants. RESULTS: Eleven mothers of premature infants participated in the evaluation of the appropriateness of the video as a teaching method and for educational content. They reported that the content on mother-infant interaction, maternal sensitivity, and maternal role confidence was especially beneficial. CONCLUSION: The findings indicate that video program is effective for education on maternal-premature infant interaction and the use of video in practical settings is strongly recommended.

Lamin A/C mutations associated with familial and sporadic cases of dilated cardiomyopathy in Koreans

Dilated cardiomyopathy (DCM) is characterized by cardiac dilation and systolic dysfunction. So far sixteen genes have been shown to cause autosomal dominant familial dilated cardiomyopathy (FDC). We identified a large Korean family from the Jeju island showing a clear Mendelian inheritance of FDC. A genomewide linkage scan at 9 cM marker density identified a peak multipoint LOD score of 2.82 at D1S195. Haplotyping of the region with 15 additional markers defined a candidate interval that included a known candidate gene encoding the lamin A/C (LMNA). Sequencing of the LMNA exons revealed one missense mutation at C568T (Arg190Trp) in the alpha-helical rod domain of the LMNA gene cosegregating with FDC with conduction-system disease. The same mutation was found in patients of another Korean family with FDC without conduction-system disease. Upon screening 14 sporadic DCM cases, we found three LMNA mutations including a case having a previously described (Glu161Lys) mutation and two having novel mutations (Glu53Val and Glu186Lys). Our results suggest that variable genotypes of laminopathy are implicated in not only familial but also considerable proportion of sporadic DCM.

Test on the Cost and Development on the Payment System of Home Health Care Nursing / 간호학회지

PURPOSE: This study focused on analysing costs per home health care nursing visit based on home health care nursing activities in medical institutes. METHOD: The data was collected in three stages. First, the cost elements of home health care nursing services were collected and 31 home care nurses participated. Second, the workload and caseload of home care nursing activities were measured by the Easley-Storfjell Instrument(1997). Third, the opinions on improving the home health care nursing reimbursement system were collected by a nation-wide mailing survey from a total of 125 home care agencies. RESULT: The cost of home health care nursing per visit was calculated as 50,626 won. This was composed of a basic visiting fee of 35,090 won (about 35 dollars) and travel fee of 15,536 won (about 15 dollars). The major problems of the home care nursing payment system were the low level of the cost per visit, no distinction between first visit and revisits, and the limitations in health insurance coverage for home health care nursing services. CONCLUSION: This study's results will contribute as a baseline for establishing policies for improvement of the home health care nursing cost and for applying a community-based visiting nursing service cost.