Cutaneous adverse drug reactions are common and produce easily identifiable clinical symptoms. These may range from mild maculopapular rashes to severe reactions associated with systemic disease.Current Concepts: The most common presentation of a drug eruption is in the form of a maculopapular rash or exanthematous skin eruption, followed by fixed drug eruptions and urticaria. Severe cutaneous adverse drug reactions include Stevens-Johnson syndrome/toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms, which are rare but potentially life-threatening. Recently, it has emerged that cutaneous adverse drug reactions associated with newly developed drugs, such as epidermal growth factor receptor inhibitors, may induce a variety of cutaneous manifestations.Discussion and Conclusion: Although certain drugs, such as antimicrobials and anticonvulsants, can frequently cause drug eruptions, their effects may change, depending on the situation and timing. Therefore, in order to resolve symptoms and prevent complications, early diagnosis, drug identification, and appropriate treatment should be performed, in consideration of the various factors involved.

Purpose: The purpose of this study was to identify the factors influencing organizational commitment of staffs according to the size of long-term care facility. Methods: A cross-sectional descriptive study was designed. Data collection was conducted for a total of 315 employees in long-term care facilities located in Seoul, Gyeonggi, Gangwon, Gyeongbuk, and Chungnam. Data were collected from July 2018 to October 2018 using questionnaires which included emotional labor, job satisfaction, organizational commitment, and general characteristics. In order to confirm the differences in the size of the facility, the facilities with less than 30 beds, those with 30-99 beds, and those with more than 100 beds were analyzed. Data were analyzed using descriptive statistics, t-test, ANOVA, Mann-Whitney U test, Kruskal-Wallis H test, Pearson's correlation analysis, and multiple regression. Results: The job satisfaction and organizational commitment were significantly different according to the size of long-term care facility. Organizational commitment was influenced by ‘external job satisfaction’ in less than 30 beds, was influenced by ‘external job satisfaction, and attentiveness to required display rules of emotional labor’ in 30~99 beds, and then was influenced by ‘type of job, and internal job satisfaction’ in more than 100 beds. The predict variables accounted for 23.0%, 41.0%, and 34.0% of organizational commitment respectively. Conclusion These findings show that tailored interventions should be provided depending on the size of facility in order to increase organizational commitment. In addition, organizational commitment programs should be developed by considering strategies to reduce the emotional labor and to increase job satisfaction.

OBJECTIVE: Recently some behavioral features and affective traits are considered important for the phenotype of obsessive-compulsive disorder (OCD). The purpose of this study was to assess some specific behavioral, temperamental, emotional features of OCD patients and to investigate if there is any change in patterns of temperament-character after 4-month pharmacotherapy. METHODS: Fifty-six patients with OCD and 70 normal controls were enrolled in this study. Four self-report questionnaires were employed to assess temperamental characteristics and affective traits: The behavioral inhibition system and behavioral activation system scale, the Baratt impulsiveness scale, state-trait anger expression inventory, emotional intelligence inventory. Among 56 OCD patients, 21 subjects started pharmacotherapy and 4 months later, they repeated 4 self-report tests as the same above and Yale-Brown obsessive compulsive scale (Y-BOCS). And then we investigated the changes from initial results. RESULTS: Patients with OCD showed significantly greater expression of behavioral inhibition system (p<0.0001), more cognitive impulsiveness (p<0.0001), motor impulsiveness (p=0.0067) and increased level of state anger (p<0.0001), trait anger (p<0.0001) than healthy controls. Compared to the controls, the OCD patients also expressed significantly lower level of emotional intelligence for using to facilitate thinking (p<0.0001) and managing emotions (p<0.0001). After 4-month pharmacotherapy for 21 OCD patients, Y-BOCS scores significantly decreased while self-report tests showed no meaningful differences from baseline assessments. CONCLUSION: Our results suggest that patients with OCD may have some differences in behavioral and affective tendencies including behavioral inhibition, impulsiveness, anger experiences, and emotional patterns. And short term pharmacotherapy during 4 months improved the severity of obsessive-compulsive symptoms but didn't influence these traits. These results provide some perspectives about possible vulnerability or trait markers of OCD. Further research is needed to examine the effects of long term treatment and other investigation might be helpful to assess the relationships between these behavioral and affective aspects and clinical phenotypes of OCD.
Anger ; Emotional Intelligence ; Humans ; Obsessive-Compulsive Disorder ; Phenotype ; Surveys and Questionnaires ; Temperament ; Thinking

Gynandroblastoma is an extremely rare sex cord-stromal tumor with both female (granulosa cell tumor) and male (Sertoli-Leydig cell tumor) elements. Juvenile granulosa cell tumors are also very rare and are so named because they usually occur in children and adolescents. A 71-year-old woman with right upper quadrant abdominal pain visited our hospital. Pelvic computed tomography showed a large multilocular cystic mass, suspected to be of ovarian origin. We performed a total abdominal hysterectomy (total abdominal hysterectomy was performed) with bilateral salpingo-oophorectomy. A 13-cm multilocular cystic mass with serous fluid was observed in her right ovary. Upon microscopic examination, the solid component of the mass showed both Sertoli-Leydig cell and juvenile granulosa cell differentiation, which we diagnosed as gynandroblastoma. Gynandroblastoma with a juvenile granulosa cell tumor component is extremely rare and, until now, only six cases have been reported in the English literature. We report the first gynandroblastoma with a juvenile granulosa cell tumor component diagnosed in an elderly patient, along with a literature review.
Abdominal Pain ; Adolescent ; Aged ; Child ; Female ; Granulosa Cell Tumor ; Granulosa Cells ; Humans ; Hysterectomy ; Male ; Ovary ; Postmenopause ; Sex Cord-Gonadal Stromal Tumors

PURPOSE: This study was conducted to adapt the standardized evidence-based nursing protocol using the IPC (intermittent pneumatic compression) intervention to prevent venous thromboembolism in surgical patients. Further, an investigation was done to measure knowledge on prevention of venous thromboembolism, surrogate incidence of venous thromboembolism and to assess IPC compliance in the study patients compared with those in surgical patients who underwent IPC intervention due to previous clinical experience. METHODS: An analysis was done of the nine modules suggested by National Evidence-based Healthcare Collaborating Agency (NECA) in the adaptation manual of the clinical practice guideline for protocol adaptation. A nonequivalent control group post test design as a quasi-experiment was used to verify the effect of the IPC protocol. RESULTS: There was a significant difference in knowledge of prevention of venous thromboembolism, IPC application time after intervention and the number of IPC applications between the experimental group (n=50) using the IPC nursing protocol and the control group (n=49). However, the symptoms of deep vein thrombosis and pulmonary thromboembolism were not observed in either the experimental group or the control group after the intervention. CONCLUSION: Results confirm that the standardized IPC nursing protocol provides effective intervention to prevent venous thromboembolism in surgical patients.
Compliance ; Evidence-Based Nursing ; Evidence-Based Practice ; Humans ; Incidence ; Intermittent Pneumatic Compression Devices ; Nursing Assessment* ; Nursing* ; Pulmonary Embolism ; Venous Thromboembolism* ; Venous Thrombosis

A 70-year-old female was referred for brown-to-gray colored papules and nodules on her lower legs. She had been diagnosed with diffuse large B-cell lymphoma (DLBCL) in her stomach, and myelodysplastic syndrome (MDS) by bone marrow biopsy. Three years after complete remission of DLBCL, she experienced DLBCL recurrence in her small bowel and was hospitalized. MDS had been stationary, but during the treatment of DLBCL, her laboratory findings suggested signs of leukemia. Bone marrow biopsy was done, and acute monoblastic leukemia (AMoL) was diagnosed. After 1 cycle of chemotherapy for AMoL, skin lesions developed, and her skin biopsy showed cutaneous T-cell lymphoma (CTCL). Terminal deoxynucleotidyl transferase staining and CD123 staining were negative, and bone marrow re-biopsy conducted after the skin lesion developed still showed monoblastic proliferation. Whether the CTCL represented with an AMoL lineage switch could not be completely proved due to the absence of molecular or clonal marker evaluations, but the possibility of coexistence of three different malignancies was higher. During treatment, a neutropenic fever developed, and the patient died due to sepsis. We herein report a rare case of CTCL accompanied by AmoL and DLBCL.

No abstract available.
Down Syndrome* ; Leukemia*

Lymphoepithelioma-like carcinoma (LELC) is an undifferentiated carcinoma with predominant lymphocytic infiltration, which is associated with Epstein-Barr virus (EBV) in variable proportions. We report two cases of carcinoma with predominant lymphoid stroma in hepatobiliary system. The first case was a lymphoepithelioma-like undifferentiated carcinoma with focal differentiation of cholangiocarcinoma (cytokeratin 19+) and hepatocellular carcinoma in light microscopy. The infiltration of CD8+ T lymphocytes was observed in the tumor and the surrounding hepatic parenchyme. In this tumor, EBV was detected and LMP1 was positive immunohistochemically. The second case showed the mixed features of lymphoepithelioma-like carcinoma and cholangiocarcinoma with predominant lymphoid stroma. In this case, EBV was detected. LELC of hepatobiliary system is an entity distinguished from conventional carcinoma with lymphoid stroma, and its association with EBV warrants further research.
Bile Duct Neoplasms/*diagnosis/pathology ; *Bile Ducts, Intrahepatic ; CD8-Positive T-Lymphocytes/pathology ; Carcinoma/*diagnosis/pathology ; Cholangiocarcinoma/*diagnosis/pathology ; Herpesvirus 4, Human/isolation & purification ; Humans ; Liver Neoplasms/*diagnosis/pathology ; Lymphocytes, Tumor-Infiltrating/*pathology ; Male ; Middle Aged ; Tomography, X-Ray Computed

Cranial fasciitis is a rare fibroblastic tumor which shows a predilection for the scalp and skull of youngchil-dren. Histologically, cranial fasciitis is identical to nodular fasciitis which is typically found in theextremities of adults, though is unique in that it may present as an osteolytic lesion of the skull. We report acase of cranial fasciitis in a 20-month-old girl, describing the ultrasonography, CT and MRI findings.
Adult ; Child* ; Fasciitis* ; Female ; Fibroblasts ; Humans ; Infant ; Magnetic Resonance Imaging ; Scalp ; Skull ; Ultrasonography

Hemodialysis(HD)-associated hypotension is a frequent complication, but it is difficult to manage. Until now, several maneuvers have been tried to prevent the HD-associated hypotension. Of these, the sodium content of dialysate was regarded as an important factor for maintaining blood pressure during HD. In this study, we evaluated the effect of hypertonic dialysate on blood pressure, interdialytic weight gain and the incidence of thirst. The study was done for 6 weeks successively with 3 different groups. Each patient was dialysed with 3 different dialysates for 2 weeks: Group I(Conventional HD: sodium concentration: 137 mEq/L), Group II(Hypertonic HD: 147 mEq/L) and Group III (Sequential HD: from 147 to 140 mEq/L). Hemodynamic parameters(blood pressure, pulse rate and ultrafiltration rate), biochemical parameters(hematocrits, blood urea nitrogen, creatinine, osmolality, sodium, potassium, chloride, fasting blood sugar) and complications (interdialytic weight gain &thirsty sensation) were compared among 3 groups. The results were as follows: 1. Decline of systolic blood pressure and diastolic blood pressure at the time of a 3 hour check during hemodialysis was lower in the Group II than Group I and III (p=0.002; p=0.012). and decline of diastolic blood pressure at the time of a 4 hour check during hemodialysis was lower in the Group II and III than Group I(p=0.04). 2. ncidence of hypotensive episodes during dialysis was significantly lower in Group II than group I (p=0.0287). 3. The ultrafiltration in Group III at the time of 1 hour, 2 hour and 3 hour check during hemodialysis was higher than that in Group I and II at the time of 1 hour, 2 hour and 3 hour check during emodialysis respectively (p=0.0001; p=0.0001; p=0.0004). 4. Interdialytic weight gain was higher in Group II(3.1+/-0.8) than GroupI(2.8+/-0.8) and III (2.9+/-0.9) (p=0.0422). 5. Hematologic and biochemical results were not significantly different among 3 Groups. 6. Frequency of thirst was different in Group I, II and III, 0.05+/-0.12, 0.41+/-0.24 and 0.22+/-0.29 respectively (p=0.0259). The results suggest that hypertonic HD was effective in preventing HD-associated hypotension but interdialytic weight gain and thirst sensations were increased as compared with a conventional method. In this situation, sequential HD seems to be an alternative method to minimizes the side effect of hypertonic HD.
Blood Pressure* ; Blood Urea Nitrogen ; Creatinine ; Dialysis ; Dialysis Solutions ; Fasting ; Hemodynamics* ; Humans ; Hypotension ; Incidence* ; Osmolar Concentration ; Potassium ; Renal Dialysis* ; Sensation ; Sodium ; Thirst* ; Ultrafiltration* ; Weight Gain*