BACKGROUND: The apnea test is an essential component in the clinical determination of brain death, however it may incur a significant risk of complications such as hypotension, hypoxia and even cardiac arrest. We analyzed the risk factors associated with a failed apnea test during brain death assessment in order to predict and avoid these adverse events. METHODS: Medical records on apnea tests performed for brain-dead donors at our institution between January 2009 and January 2016 were retrospectively reviewed. Age, gender, etiology of brain death, use of catecholamines and results of arterial blood gas analysis (ABGA), systolic/diastolic blood pressure (SBP/DBP), mean arterial pressure and central venous pressure prior to apnea test initiation were collected as variables. A-a gradient and P(aO2)/F(iO2) were calculated for more precise assessment of the respiratory system. In total, 267 cases were divided into two groups based on those who completed the apnea test and those who failed the test. RESULTS: 13 cases failed the apnea test. Among them, seven cases failed due to severe hypotension (SBP < 60 mmHg) and the others failed due to refractory hypoxia. In terms of hemodynamic state, SBP was significantly higher in the completed test group than the failed group (126.5 ± 23.9 vs. 103 ± 15.2, respectively; p = 0.001). In ABGA, the completed test group showed significantly higher P(aO2)/F(iO2) (313.6 ± 229.8 vs. 141.5 ± 131.0, respectively; p = 0.008) and a lower A-a gradient (278.2 ± 209.5 vs. 506.2 ± 173.1, respectively; p = 0.000). In multivariable analysis, low SBP (p = 0.003) and high A-a gradient (p = 0.044) were independent risk factors associated with a failed apnea test. CONCLUSIONS: Although the unexpected adverse events during the apnea test for brain death determination do not occur frequently, they can be fatal. If a brain-dead patient has low SBP and a high A-a gradient, clinicians should pay more attention and prepare for potential complications prior to the apnea test.
Anoxia ; Apnea* ; Arterial Pressure ; Blood Gas Analysis ; Blood Pressure ; Brain Death* ; Brain* ; Catecholamines ; Causality ; Central Venous Pressure ; Heart Arrest ; Hemodynamics* ; Humans ; Hypotension ; Medical Records ; Respiratory System ; Retrospective Studies ; Risk Factors ; Tissue Donors

We report a case of adult granulosa cell tumor arising in the scrotal tunics. The patient was a 34-year-old man who presented with right scrotal swelling, first noticed four months previously. Under the initial clinical impression of epididymo-orchitis, antibiotic treatment was instituted but there was no response. The paratesticular nodules revealed by ultrasound and magnetic resonance imaging mimicked intratesticular lesion, and radical orchiectomy was performed. Although several cases of adult testicular granulosa cell tumor, have been reported, the occurrence of this entity in the paratesticular area has not, as far as we are aware, been previously described.
Adult ; Case Report ; Granulosa Cell Tumor/*diagnosis/surgery ; Human ; Magnetic Resonance Imaging ; Male ; Scrotum/*pathology/*ultrasonography ; Testicular Neoplasms/*diagnosis/surgery

No abstract available.
Cafe-au-Lait Spots ; Nevus*

BACKGROUND: Myocardial ischemia in human hypertension and in various animal models of hypertension may be due to abnormal maximal coronary vasodilator reserve and disturbaces of coronary vasomotion. The vascular reactivity defects in hypertension have been associated with the defective endothelium and sympathetic neural activation. However, such abnormalities in hypertension need to be elucidated. In the present study the effectsof cardiac ischemia reperfusion on coronary circulation, intramyocytic adenylates and purine nucleosides were examined in Langendorff-perfused Sprague Dawley rat (SD) and spontaneously hypertensive rat (SHR) hearts. Coronary venous and cardiac lactate and cardiac pyruvate were also measured. It should be noted that in the regulation of coronary flow the intrinsic flow autoregulation is highly variable due to coexisting metabolic flow control, and that natural coronary flow and cardiomyocytic energy state are normally reciprocally related in perfused heart. METHODS: For the Langendorff heart perfusion, bicarbonate perfusion buffer (pH 7.40+/-0.02,37degrees C) was equilibrated with 95% O2 : 5% CO2 and contained 5mM glucose (+5U/1 insulin) and 2mM pyruvate as energy-yielding substrates. Global hypoperfusion ischemia was induced by lowering coronary perfusion pressure of 100 to 40 cmH2O, followed by 20 min reperfusion. RESULTS: During the ischemia and reperfusion, metabolic acidosis and enhanced venous lactate output in SHR were observed with increases in coronary vascular resistance and myocardial oxygen consumption.In addition, coronary reactive hyperemia during reperfusion was depressed. Although ischemia-induced increase in combined adenosine plus inosine were abolished during prolonged reperfusion, SD still exhibited coronary vasodilation. The depressed reactive hyperemia in SHR was associated with decreases in cardiac adenosine triphosphate (ATP) pool and creatine phosphate/inorganic phosphate (CrP/Pi) ratio and an increase in cardiac lactate/pyruvate ratio. CONCLUSION: This abnormal vascular reactivity during ischemia and reperfusion in SHR may be in part due to an alteration in the cardiac energy state and hence to a mismatch between myocardial metabolic demand and supply.
Acidosis ; Adenosine ; Adenosine Triphosphate ; Animals ; Coronary Circulation ; Creatine ; Endothelium ; Glucose ; Heart* ; Homeostasis ; Humans ; Hyperemia ; Hypertension ; Inosine ; Ischemia ; Lactic Acid ; Models, Animal ; Myocardial Ischemia ; Oxygen ; Perfusion* ; Purine Nucleosides ; Pyruvic Acid ; Rats ; Rats, Inbred SHR* ; Reperfusion ; Vascular Resistance ; Vasodilation

No abstract available.
Coronary Circulation* ; Heart* ; Rats, Inbred SHR*

PURPOSE: The purpose of the study was to explore factors influencing turnover intention of new graduate nurses according to length of services. METHODS: From May to July, 2017, a survey was conducted among 220 nurses working in four hospitals. Inclusion criteria were new graduate nurses who had careers of less than 16 months. Data were collected on organizational socialization, support in work place, job stress, and turnover intention. RESULTS: Satisfaction with current work department, job satisfaction, organizational commitment, and job stress were significant factors influencing turnover intention of new nurses with less than six months experience. However, in case of nurses with seven to 15 months experience, only organizational commitment influenced turnover intention. CONCLUSIONS: These findings indicate that the factors influencing turnover intention are different according to the length of time the new graduate nurses have worked. To reduce the turnover intention of new nurses, it is necessary to differentiate human resource management approaches according to length of employment. The study results could be useful evidence for developing strategies to reduce turnover in new nurses.
Employment ; Humans ; Intention ; Job Satisfaction ; Personnel Turnover ; Socialization ; Workplace

PURPOSE: The purpose of this study is to investigate clinical features and causative organisms in febrile infants younger than three months, to help identification of high risk patients for serious bacterial infection (SBI). METHODS: A total of 313 febrile infants younger than three months, who had visited Seoul National University Children's Hospital from January 2008 to December 2010 were included. Clinical features, laboratory findings, causative organisms, and risk factors of SBI were analyzed by retrospective chart review. Causative bacterial or viral pathogens were identified by gram stain and cultures, rapid antigen tests, or the polymerase chain reaction from clinically reliable sources. RESULTS: Among 313 infants, etiologic organisms were identified in 127 cases (40.6%). Among 39 cases of bacterial infections, Escherichia coli (66.7%) and Streptococcus agalactiae (12.8%) were common. Enterovirus (33.7%), respiratory syncytial virus (19.8%), and rhinovirus (18.8%) were frequently detected in 88 cases of viral infection. Patients with SBI (39 cases) showed significantly higher values of the white blood cell count (14,473+/-6,824/mm3 vs. 11,254+/-5,775/mm3, P=0.002) and the C-reactive protein (6.32+/-8.51 mg/L vs. 1.28+/-2.35 mg/L, P<0.001) than those without SBI (274 cases). The clinical risk factors for SBI were the male (OR 3.7, 95% CI 1.5-8.9), the presence of neurologic symptoms (OR 4.8, 95% CI 1.4-16.8), and the absence of family members with respiratory symptoms (OR 3.6, 95% CI 1.2-11.3). CONCLUSION: This study identified common pathogens and risk factors for SBI in febrile infants younger than three months. These findings may be useful to guide management of febrile young infants.
Bacterial Infections ; C-Reactive Protein ; Enterovirus ; Escherichia coli ; Fever ; Humans ; Infant ; Infant, Newborn ; Leukocyte Count ; Male ; Neurologic Manifestations ; Polymerase Chain Reaction ; Respiratory Syncytial Viruses ; Retrospective Studies ; Rhinovirus ; Risk Factors ; Sepsis ; Streptococcus agalactiae

BACKGROUND: Beta-adrenergic receptor Kinase 1(betaARK1) is a serine/threonine kinase attached, which inhibits the coupling of beta-adrenergic receptor with G-protein. Myocardial betaARK1 level is usually elevated in heart failure and hypertrophy, but it is not known whether the circulating betaARK1 level is related with the degree of cardiac hypertrophy. This study was performed to evaluate the association of the betaARK1 level in circulating mononuclear leukocytes(MNL) in untreated hypertension with left ventricular mass in hypertensive patients. Method: Nineteen non-treated hypertensive patients were included for this study. High blood pressure was confirmed when systolic BP is over 150 mmHg or diastoli BP is over 95 mmHg. Echocardiography was performed to evaluate the degree of hypertrophy by measuring the left ventricular mass index(LVMI) and relative wall thickness(RWT), and test the LV function by measuring the ejection fraction(EF) according to ASE guideline. At the same time, blood was collected from each patient and MNL were isolated by gradient centrifuge with Ficoll-400. Total RNA was purified from MNL and semi-quantitative RT-PCR was performed. After reverse transcription, PCR was done with primers for human betaARK1 and GAPDH as external control. betaARK1 levels were expressed by ratio to GAPDH level and estimated the relations with clinical and Echocardiographic parameters. Result: We studied confirmed 19 hypertensive patients(10 men and 9 women, mean age of 50.6 years). Echocardiographically measured indices(mean+/-SD) were as follows; LVMI(137.3+/-30.6g/m2), PWT(0.53+/-0.09) and EF(54.6+/-8.5%). Ratio of betaARK1 levels to GAPDH was from 0.10 to 0.96 (0.62+/-0.25). betaARK1 levels were correlated with LVMI(correlation coefficient: r=.502, p=.029) and RWT(r=.627, p=.004). But Systolic BP(r=0.009, p=.93), diastolic BP(r=.07, p=.85) or EF(r=.045, p=.84) were not related to level of betaARK1. CONCLUSIONS: The betaARK1 level of circulating MNL was correlated well with the degree of the cardiac hypertrophy estimated by LVMI and RWT. This data suggests that activation of sympatho-adrenal system would exert a major role in developing cardiac hypertrophy and we can expect the decreased responsiveness to catecholamine in the heart of hypertensive patients. betaARK1 in circulating MNL might be used as a predictor or marker for LV hypertrophy in hypertensive patients.
beta-Adrenergic Receptor Kinases ; Cardiomegaly ; Echocardiography ; Female ; GTP-Binding Proteins ; Heart ; Heart Failure ; Humans ; Hypertension ; Hypertrophy ; Leukocytes, Mononuclear* ; Male ; Phosphotransferases ; Polymerase Chain Reaction ; Reverse Transcription ; RNA

Improvement of lichen planus was achieved by 11 weeks of daily oral treatment with griseofulvin. The patient was 59-year-old male, has had hypertension and diabetes mellitus for 9 months, and history of various drug intake to these diseses for 6 months. Four months before first visit, symptome of lichen planus had developed suddenly. Because of treatment failure of oral antihistamine and topical steroid for 6 weeks, we began to use griseofulvin. Praspective studies are needed to better assess the affectiveness of griseafulvin in the treatment of lichen planus.
Diabetes Mellitus ; Griseofulvin* ; Humans ; Hypertension ; Lichen Planus* ; Lichens* ; Male ; Middle Aged ; Treatment Failure

Fisting is an uncommon sexual activity, and death due to fisting is very rare. In the present report, we describe a case of a woman who died from fisting by her male partner. A 38-year-old woman went to a motel with a man after consuming alcohol, and there they kissed each other. As desired by woman, the man inserted his fingers into her vagina and anus, and later inserted his fist and forearm into her vagina and anus. After 20-30 minutes of fisting, the woman became unconscious and died. The autopsy confirmed the presence of perineal and vaginal lacerations with massive internal pelvic soft tissue injury with uterine artery rupture. A partial tear was noted at the rectosigmoid junction. The cause of death was hypovolemic shock due to uterine artery rupture. Following court trials, the assailant was sentenced to 4 years of imprisonment for the felony of inflicting bodily injury resulting in death.
Anal Canal ; Autopsy ; Cause of Death ; Female ; Fingers ; Forearm ; Humans ; Lacerations ; Male ; Rupture ; Sexual Behavior ; Shock ; Soft Tissue Injuries ; Unconscious (Psychology) ; Uterine Artery ; Vagina