PURPOSE: The purpose of this study was to identify the relationship of job stress, state of sleep, and depression and to identify factors influencing depression of emergency medical technicians. METHODS: The research was a cross-sectional, descriptive study. Data collection were done using self-report questionnaires with 162 emergency medical technicians working in hospitals who agreed to participate in the study. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients and multiple regression with the SPSS/WIN 18.0 Program. RESULTS: Depression had significant negative correlations with state of sleep, (r=-482, p<.001) and positive correlations with job stress (r=.196,p=.013). State of sleep had significant negative correlations with job stress (r=-.168, p=.033). The variance for life satisfaction was 23.7% (F=25.964, p<.001). Variable of state of sleep significantly predicted depression of emergency medical technicians. CONCLUSION: Considering these results, for emergency medical technicians' job stress, state of sleep, and depression, further studies are needed. Furthermore, there is a need to develop and implement new strategies to improve depression among emergency medical technicians.
Data Collection ; Depression ; Emergencies ; Emergency Medical Technicians ; Humans ; Surveys and Questionnaires

Necrobiotic xanthogranuloma(NXG) is a characteristic cutaneous manifestation associated with paraproteinemia. A case of NXG associated with an IgG (lambda) monoclonal gammopathy occurred in a 48-year-old man. Skin lesions were dome-shaped, hard palpable nodules, 2x3 cm to 4x4 cm sized, on both arms and forearms. They were arranged in a linear pattern. Also, hard palpable tumors, 1x2 cm to 2x3 cm in size, were present on the left leg and the dorsum of the left foot. They were violaceous, slightly protruded, and hard on palpation. Histologically, the lesion was characterized by inflammatory xanthogranuloma with broad hands of hyaline necrobiosis. Many foreign body type of bizarre giant cells, Touton type of giant cells and foamy histiocytes were infiltrated into the dermis and subcutaneous fat tissue. Three days after medication with ledercort and immuran, the cutaneous masses decreased in size and became soft.

Purpose: The purpose of this qualitative study was to describe the essence and the meaning of nurses’ experiences of end-of-life care (EOLC) for elderly patients in the long-term care hospitals (LTCHs). Methods: Data were gathered from 12 nurses who had been working at LTCHs in Korea through one-on-one interviews and the data were analyzed by Colaizzi's phenomenological method. Results: The emergent 5 themes were ‘Doing the best for protecting patients’ life’, ‘Providing a comfortable dying process for patients’, ‘Supporting a family’s keeping on patient’s death’, ‘Reflecting on life’ and ‘Desiring for the establishment of a humanity end-of-life care environment’. Conclusion The end-of-life care for the elderly patients includes supporting elderly patients’ comfortable dying process and helping the family keep the death of the elderly. The results indicated that physical facilities and end-of-life nursing capacity should be established in LTCHs for improving the quality of EOLC.

Forty eight skin biopsies obtained from 24 patients were reviewed, and clinical, histological and immunohistochemical findings were analyzed. Results obtained are as follows: 1) Skin manifestation was plaque, erythroderma, scale and hyperpigmentation in mycosis fungoides, and subcutaneous nodule, mass and ulcerated patch in cutaneous lymphoma. The skin of lymphomatoid papulosis revealed hemorrhagic ulcerated and erythematous papules which healed spontaneously. 2) Histologically, mycosis fungoides showed epidermotropism in most cases. Pautrier's micro-abscesses were present in one-fourth of the cases. Malignant lymphoma was different in histology from mycosis fungoides. As compared with mycosis fungoides, it showed less frequent epidermotropism, more compact and diffuse infiltration of atypical lymphocytes, more often association with ulcer and necrosis, and more frequent mitotic figures. Lymphomatoid papulosis showed striking hemorrhage and edema of the papillary dermis. 3) Based on the results of immunohistochemical study, mycosis fungoides and lymphomatoid papulosis were considered as a T cell proliferative disorder of the skin. According to these findings, lymphoproliferative disorders of the skin occurred predominantly in the elderly and males. Clinical and histopathologic findings overlapped and were similar each other. It was difficult to make a definite diagnosis in early lesions, and a sequential follow up biopsy was required. It is concluded that strict criteria such as marked atypia and clustering of atypical cells are necessary for a histologic diagnosis of malignant lymphoproliferative disorder of the skin.
Biopsy

PURPOSE: The purpose of this study was to explore the experiences of family caregivers who care for the elderly under Long-term Care Insurance. METHODS: Data were collected using focus group interviews and analyzed using a phenomenological approach. The four focus groups consisted of eight caregivers, two social workers and three nurses in B city, Korea. RESULTS: Five themes were identified: 'Obtaining a care-helper certification for employment', 'Taking care of the elderly in their homes', 'Difficulties due to life changes', 'Difficulties due to reduced wages' and 'Dissatisfaction with the Long-term Care Insurance operating system'. CONCLUSION: The results of this study demonstrate that the long-term care system for family caregivers faces many systematic challenges in providing care for the elderly harmoniously in their home. To help them succeed in their tasks, Long-term Care Insurance system must offer respite and support programs to family caregivers.
Aged ; Caregivers ; Certification ; Focus Groups ; Humans ; Insurance ; Insurance, Long-Term Care ; Long-Term Care ; Qualitative Research ; Social Workers

BACKGROUND: Core needle biopsy (CNB) is widely used as the initial sampling method for breast cancer. And because frozen section (FS) diagnosis is rapid and reliable, we studied the diagnostic agreement between the diagnosis of FS of CNB and final diagnosis after surgery to evaluate the diagnostic accuracy of the FS of CNB. METHODS: Of 409 patients who were preoperatively diagnosed by FS of CNB and who underwent final surgery from 1996 through 2000, 24 cases were found to be ductal carcinoma in situ (DCIS) and 385 cases invasive carcinoma (IC). The diagnoses of FS of CNB were compared with final diagnoses. RESULTS: The diagnostic accuracy of carcinoma is 63.6% for DCIS and 86.9% for invasive carcinoma. Five cases (1.2%) could not be diagnosed because of material insufficiency for diagnosis. Twenty two cases (5.4%) were diagnosed as benign on FS, among which 20 (90.9%) were misdiagnosed by sampling error. Twenty seven cases (6.7%) were deferred on FS, 4 of these cases were DCIS, 5 were invasive lobular carcinoma (ILC), the rest displayed low nuclear grades or marked freezing artifacts. CONCLUSIONS: The diagnostic accuracy of FS of CNB is very high except for cases of ILC and low grade DCIS. Considering the advantage of rapid evaluation, more definitive diagnosis, familiarity by pathologists and availability of ancillary study, FS of CNB is very useful method as the preoperative evaluation.
Animals ; Artifacts ; Biopsy, Large-Core Needle* ; Biopsy, Needle ; Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Diagnosis ; Freezing ; Frozen Sections* ; Humans ; Mammary Neoplasms, Animal ; Recognition (Psychology) ; Selection Bias

Mutation of the p53 gene is one of the most common genetic alterations in invasive breast carcinoma. However, it is unclear that the mutation usually occurs in noninvasive breast lesions. It might be expected that there is a correlation between histologic progression of breast lesions and proliferative rate. We investigated the expression of p53 protein and Ki-67 labelling index (LI) using immunohistochemistry in 16 ductal carcinoma in situ with microinvasion (DCIS-Mi), 56 DCIS, 15 atypical ductal hyperplasia (ADH), and 7 intraductal hyperplasia (IDH). Expression of p53 protein was detected in 33.9% of DCIS and 56.3% of DCIS-Mi and was confined exclusively in Van Nuys DCIS group 2 and 3. In ADH and IDH, no expression of p53 protein was found. There was no significant correlation between Van Nuys DCIS groups and Ki-67 LI. In conclusion, p53 mutation may be involved in the neoplastic progression from ADH to DCIS and is directly related to high nuclear grade and associated necrosis of DCIS.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Genes, p53 ; Hyperplasia* ; Immunohistochemistry ; Necrosis

INTRODUCTION: Cathepsin D (CD) is a lysosomal protease that can be used as an important prognostic cytosolic factor for breast cancer. Its over-expression in breast cancer cells and in the host stromal cells in the tumor has been proposed as being a poor prognostic indicator. However, its prognostic value is still being debated. Therefore, CD expression needs to be examined in more relevant subsets of tissue in order to refine its prognostic significance and the clinical applications. METHODS: Regardless of the lymph node status, 110 T1 invasive ductal carcinomas of the breast were immunohistochemically evaluated for the CD expression using rabbit anti-cathepsin D monoclonal antibody. This study separately assessed the expression of CD in the invasive component (IDC), in the in situ component (DCIS), and in the juxtatumoral stromal cells (JTSC). The CD expression level in these three kinds of tissues were correlated with the nuclear grade, ER, PR, c-erb-B2, p53, the N stage, the T stage, and the 5 year metastasis-free survival. RESULTS: Positive CD expression in the JTSC was associated with the T stage (p = 0.001) and the N stage (p = 0.029), whereas positive CD expression in the DCIS and IDC was not. In addition, strong CD expression in the JTSC correlated with the nuclear grade of the invasive component (p = 0.024). In all three components, no statistically significant correlation was found between the biomarker (ER, PR, cerb-B2, p53) and the CD expression. On univariate analysis, positive expression in the JTSC was correlated with a poor 5 year- metastasis free survival (p = 0.007), but the positive expression in the IDC and DCIS was not. CONCLUSION: CD expression of the JTSC could represent the N stage, the T stage, and the nuclear grade of T1 IDC. Whether or not it would have an independent influence on the prognosis of T1 IDC, CD expression in the JTSC is probably an indicator of the tumor virulence. CD expression in the JTSC will provide an important clue for the development of new CD targeted therapies, and it will serve as an important criterion for selecting the appropriate candidates for these future targeted therapies.
Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating ; Cathepsin D* ; Cathepsins* ; Cytosol ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Stromal Cells* ; Virulence

Ramsay Hunt syndrome associated with the Varicella zoster virus (VZV) infection is characterized by vesicles on the pinna, otalgia, facial nerve palsy and sensorineural hearing loss. Although significant complications from VZV infection are increasing, thrombosis associated with VZV infection is one of the rare complications in adults. The VZV itself could cause endothelial damage in the various organs. Subsequently, the thrombosis might be complicated. A previously healthy 84 year-old female patient was diagnosed with Ramsay Hunt syndrome. On the 7th day of antiviral treatment, she complained of sudden breathlessness. She was hypoxemic with an elevated alveolar-arterial oxygen difference and needed to be supported by mechanical ventilation. Massive pulmonary thrombosis was documented by computerized tomography and she successfully underwent thrombolytic therapy. We report a case of massive pulmonary thromboembolism associated with VZV infection, treated with thrombolytic therapy.
Adult ; Earache ; Facial Nerve ; Female ; Hearing Loss, Sensorineural ; Herpes Zoster ; Herpes Zoster Oticus ; Herpesvirus 3, Human ; Humans ; Oxygen ; Paralysis ; Parkinsonian Disorders ; Pulmonary Embolism ; Respiration, Artificial ; Thrombolytic Therapy ; Thrombosis

PTEN (phosphatase and tensin homolog) is a dual specific phosphatase antagonizing phosphoinositide 3-kinase activity, and has first been cloned as a tumor suppressor for glioma. Although the role of PTEN as a tumor suppressor has been well studied, little is known about signaling mechanisms regulating expression and/or activity of PTEN in the central nervous system. In this study, we investigated whether PTEN expression is regulated by sensory deprivation. P5 rat pups were unilaterally naris-closed, and olfactory bulbs were immunohistochemically analyzed with PTEN antibody at the 7th day after naris closure. PTEN immunoreactivity was found to be down-regulated in both glomerular, external plexiform and subependymal cell layers, suggesting that odor deprivation signals down-regulate expression of PTEN in the olfactory bulb. To the best of our knowledge, this is the first report to suggest that PTEN expression is regulated by sensory deprivation signals in neonatal rats.
Animals ; Central Nervous System ; Clone Cells ; Glioma ; Odors ; Olfactory Bulb* ; Rats* ; Sensory Deprivation