Malignant melanoma is a relatively rare tumor. It represents 1.4-15.7% of all malignant tumors. Melanin-containing cells are normally found in the pia mater of adult human subjects. A wide variety of disorders ranging from a simple increase in normal leptomeningeal pigmentstion to highly malignant melanoma may be encountered. However, whether benign or malignant, primary melanoma of the nervous system are extremely rare. The diagnosis was confirmed by operation and biopsy. This case, which we have experienced recently, is reported with a review of the literatures.
Adult* ; Biopsy ; Diagnosis ; Humans ; Melanoma ; Nervous System ; Nevus* ; Pia Mater

PURPOSE: To differentiate fine hyperdense dots mimicking microcalcifications from true microcalcifications on mammography. SUBJECTS AND METHODS: Mammograms showing hyperdense dots in ten patients (mean age, 59 years) were evalvated. Two radiologists were asked to differentiate with the naked eye the hyperdense dots seen on tenmammograms and proven microcalcifications seen on ten mammograms. Densitometry was also performed for all lesions and the contrast index was calculated. The shape and distribution of the hyperdense dots were evaluated and enquiries were made regarding any history of breast disease and corresponding treatment. Biopsies were performed for two patients with hyperdense dots. RESULTS: Two radiologists made correct diagnoses in 19/20 cases(95%). The contrast index was 0.10-0.88 (mean 0.58) for hyperdense dots and 0.02-0.45 (mean 0.17) for truemicrocalcifications. The hyperdense dots were finer and homogeneously rounder than the microcalcifications. Distribution of the hypendense dots was more superficial in subcutaneous fat (seven cases) and subareolar area(six cases). All ten patients with hyperdense dots had history of mastitis and abscesses and had been treated byopen drainage (six cases) and/or folk remedy (four cases). In eight patients, herb patches had been attached. Biopsies of hyperdense dots did not show any microcalcification or evidence of malignancy. CONCLUSION: These hyperdense dots were seen mainly in older patients. Their characteristic density, shape, distribution and clinical history makes differential diagnosis from true microcalcifications easy and could reduce unnecessary diagnostic procedures such as surgical biopsy.
Abscess ; Biopsy ; Breast Diseases ; Densitometry ; Diagnosis ; Diagnosis, Differential ; Drainage ; Female ; Humans ; Mastitis ; Medicine, Traditional ; Subcutaneous Fat

PURPOSE: This study was conducted to identify risk factors in hospitalized children, and to develop and validate a fall-risk assessment tool for hospitalized children. METHODS: A retrospective chart review was performed at one university children's hospital, and an analysis was done of the characteristics of all patients who fell during a 44-month period (n=48). These patients were compared with another 149 hospitalized children who did not fall. RESULTS: Significant predictors of falls as identified in a multivariate logistic regression analyses were age of less than 3 years old, neurological diagnosis including epilepsy, children's dependency of ADL, physical developmental delay, multiple usage of fall-risk-increasing drugs. The respective odds ratios ranged from 2.4 to 7.1 with 95% confidence interval (p<0.05). Accordingly, defining patients with either 5 risk factors as fall-prone hospitalized children provided a sensitivity of 93.6% and specificity of 16.2%. CONCLUSION: The results show that this tool has an acceptable level of sensitivity to assess the risk factors of fall in hospitalized children even though the specificity was low, suggesting that this tool may enable nurses to predict the risk level of childhood falls, and develop preventive strategies against pediatric falls in children's units.
Accidental Falls ; Activities of Daily Living ; Child ; Child, Hospitalized* ; Diagnosis ; Epilepsy ; Humans ; Logistic Models ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity

Although excessive arteriovenous fistula blood flow may be a factor in the development of high-output cardiac failure, this diagnosis is easily over-looked. Surgical reduction of fistula blood flow can improve the condition. We here report a case of high-output cardiac failure due to excessive arterio-venous fistula blood flow in a hemodialysis patient. A 51-year-old man who had been treated with hemodialysis since 5 years ago was admitted for increasing cardiac failure. Echocardiographic evaluation of cardiac output and duplex measurement of the fistula confirmed the diagnosis of high-output cardiac failure due to excessive arteriovenous fistula blood flow. After surgical closure of the fistula, the signs and symptoms of cardiac failure subsequently subsided and both systolic and diastolic dimension of left ventricle much decreased.
Arteriovenous Fistula* ; Cardiac Output ; Diagnosis ; Echocardiography ; Fistula ; Heart Failure* ; Heart Ventricles ; Humans ; Middle Aged ; Renal Dialysis*

PURPOSE: To evaluate the safety and efficacy of sildenafil citrate in men with erectile dysfunction, who had been taking antihypertensive agents, and to provide supportive scientific data, which can be used as a reference when prescribing sildenafil citrate. MATERIALS AND METHODS: 198 male subjects, aged 20 years or older, between September 2002 and June 2003, were enrolled. The subjects were comprised of those patients with arterial hypertension, taking one or more antihypertensive agents, and who had been diagnosed with erectile dysfunction of more than 3 months duration. This study was conducted for 10 weeks as an open-label, multi-center and flexible dose clinical study, with a 2-week screening period and 8-week treatment phase. At all visits, the heart pressure and heart rate were measured, with any concomitant medications and adverse events recorded for each subject. Subjects were asked to complete the Event Log Worksheets, questionnaires of the International Index of Erectile Function (IIEF) and the Global Efficacy Assessment Question (GEAQ) during the study period. RESULTS: 167 subjects completed this study. The average age and duration of erectile dysfunction were 55.8 (31.7 to 77.1) years old and 3.3 years, respectively. The scores for questions 3 and 4 of IIEF improved from 2.3 and 1.8 at baseline, to 3.7 and 3.4 at week 4 and to 3.8 and 3.4 at week 8, respectively. 86.3 and 88.3% of patients answered that they had an improved erectile function and ability to have sexual intercourse, respectively, by week 8. There were no significant differences in responses to questions 3 and 4 of the IIEF and GEAQ in relation to the number of antihypertensive agents taken. The adverse events experienced during the study were facial flushing (20.1%), headache (11.7%), palpitation (5.0%), rhinitis (2.8%), URI (2.8%), dizziness (2.2%), chest pain (2.2%) and nausea (1.7%). Only 4 patients discontinued treatment due to adverse events. CONCLUSIONS: According to the results of this study, sildenafil citrate was concluded to not only be effective at improving erections, but was also well tolerated and safe in the treatment of men with erectile dysfunction who were also taking multiple antihypertensive agents for arterial hypertension.
Antihypertensive Agents ; Chest Pain ; Citric Acid ; Coitus ; Dizziness ; Erectile Dysfunction* ; Flushing ; Headache ; Heart ; Heart Rate ; Humans ; Hypertension* ; Male* ; Mass Screening ; Nausea ; Surveys and Questionnaires ; Rhinitis ; Sildenafil Citrate

OBJECTIVE: To compare the incidence and clinical characteristics of tuberculosis (tbc) between patients with systemic lupus erythematosus (SLE) and kidney transplantation (KT) recipients. METHODS: Six hundreds and twenty-two patients who were diagnosed as SLE from 1990 to 2001 in Kang-Nam St. Mary's hospital were reviewed, retrospectively. As a control group, 347 kidney transplant recipients in the same center were evaluated. The extent of tbc was categorized into two groups: (1) limited disease (2) extensive disease. Cumulative steroid dosage and disease activity index including SLEDAI, serum complement levels, and anti-dsDNA titers were compared between the two groups. RESULTS: The cumulative incidence rate of tbc was similar in both groups (37 cases and 5.7% in SLE versus 17 cases and 4.9% in KT). Mean interval from SLE diagnosis or KT to tbc development was not different between the two groups. The most common site of tbc was lung/pleura, and the others included lymph nodes (2 cases), knee joint (1), bone marrow (1), central nervous system (1), kidney (1), colon (1), liver (1), and skin (1) in SLE. In contrast, most of tbc (16/17) developed exclusively in the lung and pleura in KT recipients. Cumulative doses of prednisolone 1 or 6 months before tbc diagnosis were not different between the two groups. Interestingly, extensive disease tended to be more frequent in SLE patients than in KT recipients although immuno-suppressants such as cyclosporine and azathioprine were more frequently administered in KT recipients. There were no differences in disease activity index including SLEDAI, complement levels, and anti-ds DNA titers at the time of tbc diagnosis as well as in the cumulative doses of steroid between extensive and limited diseases of tbc in SLE. CONCLUSION: The cumulative incidence rate of tbc was higher in SLE patients than in general population. The patterns of tbc tended to be more extensive in SLE compared to KT recipients in whom a stronger immuno-suppression was required, suggesting that immune dysfunction implicated by SLE itself may play an important role in determining the incidence and patterns of tbc infection.
Azathioprine ; Bone Marrow ; Central Nervous System ; Colon ; Complement System Proteins ; Cyclosporine ; Diagnosis ; DNA ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Knee Joint ; Liver ; Lung ; Lupus Erythematosus, Systemic* ; Lymph Nodes ; Pleura ; Prednisolone ; Retrospective Studies* ; Skin ; Transplantation ; Tuberculosis*

The posaconazole tablet formulation was developed to have improved bioavailability compared to the oral suspension. Here, we compared posaconazole plasma concentration (PPC) with the posaconazole oral suspension versus the tablet in Korean patients undergoing remission induction chemotherapy for hematologic malignancies. PPC was measured at 3, 8, and 15 days of treatment with the oral suspension (174 patients) or the tablet (40 patients). At all time-points, mean PPC was significantly higher with the tablet compared to the oral suspension. Our findings suggest that posaconazole tablets generate an optimal PPC earlier and in more patients than the oral suspension among Korean patients.
Antifungal Agents ; Biological Availability ; Dosage Forms ; Drug Therapy ; Hematologic Neoplasms* ; Humans ; Plasma* ; Remission Induction ; Tablets

Background: The relationship between changes in anxiety levels and personal protective equipment (PPE) use is yet to be evaluated. The present study assessed this relationship among healthcare workers (HCWs) involved in the care of patients with coronavirus disease 2019 (COVID-19). Methods: An online survey was conducted in a municipal hospital with 195 nationally designated negative pressure isolation units in Korea. Anxiety level was measured using the self-rating anxiety scale (SAS), and changes in anxiety levels were assessed based on the time when COVID-19 vaccine was introduced in March 2021 in Korea. Monthly PPE usage between June 2020 and May 2021 was investigated. Results: The mean SAS score (33.25 ± 5.97) was within normal range and was lower than those reported in previous studies conducted before COVID-19 vaccination became available.Among the 93 HCWs who participated, 64 (68.8%) answered that their fear of contracting COVID-19 decreased after vaccination. The number of coveralls used per patient decreased from 33.6 to 0. However, a demand for more PPE than necessary was observed in situations where HCWs were exposed to body fluids and secretions (n = 38, 40.9%). Excessive demand for PPE was not related to age, working experience, or SAS score. Conclusion Anxiety in HCWs exposed to COVID-19 was lower than it was during the early period of the pandemic, and the period before vaccination was introduced. The number of coveralls used per patient also decreased although an excessive demand for PPE was observed.

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.