OBJECTIVE: To understand the clinical manifestations and disease course of adult onset Still' s disease (AOSD). METHODS: 15 patients of AOSD diagnosed at Severance hospital, Yonsei University College of Medicine were retrospectively analysed in the period of September 1988 to September 1995. RESULTS: There were 3 men and 12 women (male to female ratio of 1:4). Age of disease onset ranged from 17-55 years, and over 86% of the patients were younger than age 40 at disease onset. The prevalence of clinical features were as follows fever (100%), arthritis (93%), skin rash (93%), sore throat (60%), abnormal liver function (73%), lymphadenopathy (47%), splenomegaly (47%), hepatomegaly (20%), serositis (13%). Fever was the most common initial symptom. Common labaratory features were leukocytosis with neutrophilia (87%), anemia' Hgb <10 g/dL (67%), increased serum ferritin (83%), ESR (87%) and CRP (93%). Serum ferritin was markedly raised at disease onset and correlated with disease activity. In 2 patients, the disease was controlled with NSAID alone, but most of the patients required steroid to control the disease activity. In 6 patients, MTX was added for steroid sparing effect and for steroid resistant arthritis. Most of AOSD patients had intermittent and chronic disease course. Root joint arthritis and polyarthritis were factors associated with chronicity. CONCLUSION: The clinical features of AOSD in our study generally resemble previous reports. Serum ferritin was a useful marker of disease activity. Most patients of AOSD had intermittent and chronic disease course. Root joint athritis and polyarticular pattern at disease onset were factors associated with chronicity.
Adult* ; Arthritis ; Chronic Disease ; Exanthema ; Female ; Ferritins ; Fever ; Hepatomegaly ; Humans ; Joints ; Leukocytosis ; Liver ; Lymphatic Diseases ; Male ; Pharyngitis ; Prevalence ; Retrospective Studies ; Serositis ; Splenomegaly ; Still's Disease, Adult-Onset*

In order to determine the relationship between acid-base balance and K+ metabolism in patients whi controlled respiration during surgery, 20 patients under general anesthesia were studied. Anesthesia was induced with 2% thiopental and was maintained with halothane. Suxamethonium was used for intubation. During surgery, the respiration of the patient was controlled by a volume controlled respirator with tidal volume of 800ml and a rate of 12/min. Blood and urine samples were collected before anesthesia, and 30 and 60 minutes thereafter. REsults were as follows: Hyperventilation induced by artificial respiration during surgical anesthesia produced a significant decrease in PaCO2 from 36.1+/-1.3mmHg to 19.9+/-1.5mmHg at 30 min, and to 20.1+/-1.7mmHg at 60 min. Hyperventilation increased arterial pH from 7.41+/-0.008 to 7.49+/-0.028 at 30 min, and 7.47+/-0.011 at 60 min. Hyperventilation produced a significant decrease in serum concentration of K+ from 4.04+/-0.12 to 3.75+/-0.08mEq/l at 30min, and 3.62+/-0.05 mEq/l at 60min. Urinary excrets of K+ was not significantly altered during the hour of the hyperventilation. These results suggest that hypokalemia followed by respiratory alkasisis mainly due to the movement of K+ from extracellular to intracellular compartments rather than a change in renal excretion of K+.
Acid-Base Equilibrium ; Anesthesia ; Anesthesia, General ; Halothane ; Humans ; Hydrogen-Ion Concentration* ; Hyperventilation* ; Hypokalemia ; Intubation ; Metabolism* ; Potassium* ; Respiration ; Respiration, Artificial ; Succinylcholine ; Thiopental ; Tidal Volume ; Ventilators, Mechanical

BACKGROUND: Epidural anesthesia is thought to be relatively indicated for cesarean section in patients with severe preeclampsia. In contrast, avoidance of spinal anesthesia is recommended, postulating excessive hypotensive risks. In addition, general anesthesia is often avoided in this population because malignant hypertension following tracheal intubation is common and risks for difficult airway management are excessive. METHODS: In this study, we compared hemodynamic changes in patients with severe preeclampsia and normal pregnant women during spinal anesthesia for elective cesarean section. Spinal anesthesia was performed with 10 mg of 0.5% heavy bupivacaine mixed with 25 microgram fentanyl in 18 patients with severe preeclampsia and 17 normal pregnant women. We compared MAP, CI, and SVRI changes before and after spinal anesthesia. RESULTS: MAP responses following induction of spinal anesthesia for elective cesarean section in patients with severe preeclampsia and normal pregnant women showed a statistically significant decrease from 2 min after spinal anesthesia. CI responses following induction of spinal anesthesia in patients with severe preeclampsia showed a statistically significant increase from 8 min after and normal pregnant women also showed a statistically significant increase from 4 min after spinal anesthesia. SVRI responses from induction of spinal anesthesia in patients with severe preeclampsia and normal pregnant women showed a statistically significant decrease from 2 min after spinal anesthesia. Incidence of hypotension before delivery and used total dose of ephedrine during operation were statically insignificant between severe preeclamptic and normal pregnant women. CONCLUSIONS: We conclude that changes of MAP, CI and SVRI following spinal anesthesia for elective cesarean section in the severely preeclamptic and normal pregnant women are clinically similar. We suggest that spinal anesthesia for cesarean section is not contraindicated in the severely preeclamptic patient.
Airway Management ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal* ; Bupivacaine ; Cesarean Section* ; Ephedrine ; Female ; Fentanyl ; Hemodynamics* ; Humans ; Hypertension, Malignant ; Hypotension ; Incidence ; Intubation ; Pre-Eclampsia* ; Pregnancy ; Pregnant Women

BACKGROUND: Coal workers' pneumoconiosis is a fibrotic lung disease resulting from chronic inhalation of coal dust. The precise mechanism of lung fibrosis in coal workers' pneumoconiosis is uncertain. However, a relationship between the stimulation of fibroblast proliferation and collagen production by mediators released from inflammatory and resident lung cells is thought to be a major factor. The transforming growth factor-β(TGF-β), a multifunctional cytokine and growth factor, plays a key role in the scarring and fibrotic processes due to its ability to induce extracellular matrix proteins and modulate the growth and immune function of many cell types. To determine the involvement of TGF-βin the development of lung fibrosis in coal workers' pneumoconiosis, the TGF-β1 level in plasma was measured in patients with coal workers' pneumoconiosis. METHODS: Plasma was collected from 40 patients with coal workers' pneumoconiosis (20 with simple coal workers' pneumoconiosis and 20 with complicated coal workers' pneumoconiosis) and from 10 normal controls. The ELISA method was used to measure the plasma TGF-β1 concentration. RESULTS: Compared to the control group (0.63±0.18 ng/mL), there was no significant difference in the plasma TGF-β1 level in patients with simple coal workers' pneumoconiosis (0.64±0.17 ng/mL) (p>.05). However, in patients with complicated coal workers' pneumoconiosis the plasma TGF-β1 level (0.79±0.18 ng/mL) was significantly higher than in patients with simple coal workers' pneumoconiosis and control group (p<0.05). CONCLUSION: The data suggests that TGF-β1 has some influence in the development of lung fibrosis in coal workers' pneumoconiosis.
Cicatrix ; Coal* ; Collagen ; Dust ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix Proteins ; Fibroblasts ; Fibrosis ; Humans ; Inhalation ; Lung ; Lung Diseases ; Plasma* ; Pneumoconiosis* ; Pulmonary Fibrosis

Unicornuate uterus with a rudimentary horn hematometra and bicornuate uterus with unilateral hematometra is rare congenital anatomic anomalys of the female genital system. these patients present with dysmenorrhea, dyspareunia, pelvic mass, urinary tract anomalies and pelvic endometriosis. We have experienced a case of rudimentary uterine horn hematometra with agenesis of ipsilateral kidney and pelvic endometriosis in a 18 years old girl and a case of bicornuate uterus with unilateral hematometra associated with agenesis of ipsilateral kidney and pelvic endometriosis in a 14 years old girl. and we treated by laparoscopic management. So we report two cases with a brief review of literatures.
Adolescent ; Animals ; Dysmenorrhea ; Dyspareunia ; Endometriosis* ; Female ; Hematometra ; Horns ; Humans ; Kidney* ; Urinary Tract ; Uterus

OBJECTIVE: This study was conducted to investigate the cognitive factors that can longitudinally predict the response to treatment in patients with schizophrenia. METHODS: The subjects were 49 patients with schizophrenia who were newly hospitalized in an acute psychiatry ward and had not been treated with medication for at least 8 weeks prior to the study. The symptoms and cognitive functions of the patients were evaluated at baseline before treatment (T0), at eight weeks after treatment (T1), and one year after treatment (T2). Clinical symptoms were assessed using the PANSS, and cognitive functions were estimated using the Vigilance Test, Cognitrone Test, Wisconsin Card Sorting Test (WCST), and the Korean version of the Memory Assessment Scales (K-MAS). RESULTS: The patient group showed marked impairments in cognitive function when compared to the normal group, but the patients' clinical symptoms and cognitive functions improved after drug treatment. The patients also showed consistent improvement in verbal and nonverbal memory function as time progressed. Furthermore, there was a significant correlation between clinical symptoms and cognitive functions in the patient group. The cognitive variables that best predicted treatment response and prognosis were total errors on the WCST and immediate list recall component of the K-MAS. It was also shown that the number of total errors on the WCST was a better cognitive predictor than the number of errors in immediate recall. CONCLUSION: The results of the present study show that the neurocognitive functions of patients with schizophrenia can be stabilized with treatment intervention, that treatment response is related to improvement in cognitive function, and that cognitive domains, especially executive function, can predict treatment response and prognosis in patients with schizophrenia.
Cognition ; Executive Function ; Follow-Up Studies* ; Humans ; Memory ; Memory, Short-Term ; Prognosis ; Schizophrenia ; Weights and Measures ; Wisconsin

Objectives: ：Cancer diagnosis causes significant distress while it may also bring positive change: post-traumatic growth. This study was conducted to analyze factors that affect post-traumatic growth. Methods: ：Medical records of 52 cancer patients who received psychiatric treatment at a university hospital in Seoul were reviewed and the correlation between post-traumatic growth and following factors were analyzed: Resilience, Anxious thoughts and tendencies, Mindful attention awareness, Acceptance attitude Results: ：Using Multiple Generalized Linear model, a positive correlation was found between post-traumatic growth and resilience (B=1.45, p<0.0001), mindful attention awareness (B=0.58, p=0.0030) and acceptance attitude (B=1.29, p=0.0003), while anxious thoughts and tendencies (B=-0.84, p<0.0001) had negative association. Conclusions ：Factors that have a positive impact on post-traumatic growth were resilience, mindful attention awareness, acceptance attitude and a factor with a negative impact was anxious thoughts and tendencies; Factors that impact post-traumatic growth need to be taken into account, when approaching the treatment of cancer patients.

OBJECTIVE: Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. METHODS: We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. RESULTS: SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m², respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. CONCLUSION: Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery.
Body Mass Index ; Cystectomy ; Female ; Follow-Up Studies ; Humans ; Laparoscopy* ; Laparotomy ; Medical Records ; Minimally Invasive Surgical Procedures ; Operative Time ; Ovary ; Postoperative Complications ; Retrospective Studies

PURPOSE: This study aimed to identify multidimensional factors influencing burnout in intensive care unit(ICU) nurses. METHODS: A descriptive cross-sectional design was used. Data were collected during February 2016 from a convenience sample of 222 tertiary hospital ICU nurses and analyzed using t-test, ANOVA, correlation analysis, and multiple regression analysis. RESULTS: Burnout correlated positively with compassion fatigue (CF)(r=.37, p < .001), and negatively with compassion satisfaction (CS)(r=-.66, p < .001). The regression model explained 57% of the variance in burnout. For individual characteristics in the model, perceived health status (β=-.27, p < .001) and gender (β=.14, p=.028) were the most influential factors for ICU nurses' burnout. In the model with added work-related characteristics, nursing environment (β=-.22, p=.001), perceived health status (β=-.20, p=.001), and satisfaction with department (β=-.19, p=.007) were the most influential factors. Finally, for the model with psychological characteristics added, CS (β=-.56, p < .001) and CF (β=.35, p < .001) were the most influential factors. CONCLUSION: Results reveal that most ICU nurses have a moderate level of CF and a moderate to high level of CS and burnout, and that individual, work-related and psychological factors are relevant in ICU nurses' burnout. Programs or interventions to reduce burnout should be developed taking into account these multidimensional factors.
Compassion Fatigue ; Critical Care ; Empathy ; Intensive Care Units ; Nursing ; Personal Satisfaction ; Psychology ; Tertiary Care Centers

A C6 beta-chemokine, CKbeta8-1, suppressed the colony formation of CD34 + cells of human cord blood (CB). Molecular mechanisms involved in CKbeta8-1-medicated suppression of colony formation of CD34 + cells are not known. To address this issue, the level of various G1/S cell cycle regulating proteins in CKbeta8-1-treated CD34 + cells were compared with those in untreated CD34 + cells. CKbeta8-1 did not significantly alter the expression of the G1/S cycle regulation proteins (cyclin D1, D3, and E), CDK inhibitor (p27and Rb), and other cell proliferation regulation protein (p53) in CB CD34 + cells. Here we describe an in vitro system in which CB CD34 + cells were committed to a multipotent progenitor lineage of colony forming units-granulocyte/macrophage (CFU-GM) by a simple combination of recombinant human (rh) GM-CSF and rhIL-3. In this culture system, we found that cyclin E protein appeared later and disappeared faster in the CKbeta8-1-treated cells than in the control cells during CFU-GM lineage development. These findings suggested that cyclin E may play a role in suppressing the colony formation of CFU-GM by CKbeta8-1.
Antigens, CD34/metabolism ; Cell Cycle Proteins/metabolism ; Cell Lineage ; Cells, Cultured ; Chemokines, CC/*pharmacology ; Cyclin E/*metabolism ; Fetal Blood/*cytology ; G1 Phase/drug effects ; Gene Expression Regulation/*drug effects ; Granulocytes/cytology/*drug effects/metabolism ; Growth Substances/pharmacology ; Humans ; Macrophages/cytology/*drug effects/metabolism ; Research Support, Non-U.S. Gov't ; Stem Cells/cytology/*drug effects/metabolism