Calciphylaxis is a rare, but fatal, condition that is characterized by a rapidly progressive ischemic necrosis of the skin, underlying tissue and other organs, as well as rapid vascular calcification. It results in death due to sepsis, heart or respiratory failure. A 67-year old female was admitted to hospital with the chief complaint of constant pain to both lower legs of 1 week duration. She was treated with calcitonin-salmon due to a prior unexplained hypercalcemia of 2 weeks. On the third day post admission. pain and weakness in the lower legs were aggravated, became painful, with violaceous skin lesions developing on the thigh with findings similar to those of rhabdomyolysis. Because she was suspected of having dermatomyositis, she was treated with methylpredrisolone. However, the skin lesions and symptoms were aggravated, and she died of sepsis due to a skin infection. About 160 cases of calciphylaxis have been reported, with most of these cases being associated with secondary hyperparathyroidism due to end-stage renal disease, but cases of calciphylaxis without renal failure are very rare. We now report a case of calciphylaxis without renal failure, mimicking dermatomyositis, and present a brief review of the pathophysiology and treatments of calciphylaxis inform the relevant literature.
Aged ; Calciphylaxis* ; Dermatomyositis* ; Female ; Heart ; Humans ; Hypercalcemia ; Hyperparathyroidism, Secondary ; Kidney Failure, Chronic ; Leg ; Necrosis ; Renal Insufficiency ; Respiratory Insufficiency ; Rhabdomyolysis ; Sepsis ; Skin ; Thigh ; Vascular Calcification

The purposes of this study were to describe systematically 18 years of oncology nursing research in Korea and suggest it's direction in future. 149 nursing studies published from 1980 to 1998 were selected for the present study. There were examined the source and the design of study, type of subjects, measurement variables, the intervention outcome of experimental research, and theme of qualitative research. The results were as follows : 1. 121 of 149 studies were composed of master thesis and dissertation of graduate school. There were 55 correlations, 30 descriptions, 19 comparisons, 19 qualitative studies and 2 Q-methods as the type of research design. 2. Cancer patients without describing specified diagnose as subjects' characteristic were 44 of total studies. The others had various diagnoses such as gastric cancer, uterine cancer, breast cancer, leukemia, Iymphoma, colorectal cancer, and lung cancer. According to treatment type. patients receiving chemotherapy were the highest number distribution as 53 of all researches. 3. Most measurement instruments used for research were translated it into Korean that developed by foreigners, such as Zung's depression. Spielberg's anxiety, and Wallston's locus of control. 4. Quality of life was shown the most frequently among correlational researches. the next one was depression the third was hope, and so on. 5. There was the most frequent comparison between cancer and non-cancer patients in comparative researches. It was surveyed those variables as diet habits, risk factors, stressful life events, anxiety and depression and self-care capacity between two groups. 6. The subjects were mostly chemotherapy Patients as 15 of 24 experimental studies. Oral care and education were respectively the highest experimental interventions. 7. Qualitative researches about cancer were reported since 1991. Their themes were illness experience, adaptation process, dying experience, family experience, hope. caring, experience of health behavior, meaning of chemotherapy and experience of cancer survivor. Phenomenologic methodology was designed above 50% of qualitative researches. According to the above findings, cancer research had increased since 1990 and done mostly by descriptive design but a few experimental studies. As recommendations for the future, It is necessary to study the comparison of oncology nursing research internationally. the replication to establish the effect of nursing intervention and the family care of cancer patient.
Anxiety ; Breast Neoplasms ; Colorectal Neoplasms ; Depression ; Diagnosis ; Drug Therapy ; Education ; Emigrants and Immigrants ; Food Habits ; Health Behavior ; Hope ; Humans ; Internal-External Control ; Korea ; Leukemia ; Lung Neoplasms ; Nursing ; Oncology Nursing* ; Qualitative Research ; Quality of Life ; Research Design ; Risk Factors ; Self Care ; Stomach Neoplasms ; Survivors ; Uterine Neoplasms

BACKGROUND: It has been suggested that acromegalic patients are at increased risk of developing colonic neoplasia. We evaluated the prevalence of colonic neoplasia and the relationships of clinical parameters of acromegalic activity with presence of colonic neoplasia in Korean acromegalic patients. METHODS: In 30 patients with active acromegaly, colonoscopy was performed at the time of diagnosis. According to the endoscopic findings and histological classifications, the patients were grouped, and a number of clinical parameters of acromegalic activity were compared between those with and without colonic polyps. RESULTS: Colonic polyps were detected in 17 (56.7%) in the 30 acromegalic patients with colonoscopic examinations; 7 (23.3%) hyperplastic and 10 (33.3%) adenomatous polyps. Those with colonic polyps were significantly older (52.2+/-9.46 years vs. 42.2+/-12.97 years, p=0.02) and also had significantly longer disease duration (11.8+/-7.52 years vs. 5+/-2.20 years, p=0.004) than those without ones. In 21 patients who were more than 40 years old, significant differences were found in disease duration (12.7+/-7.54 years vs. 5.0+/-2.68 years, p=0.026) and serum IGF-1 level (1311.9+/-500.14 ng/mL vs. 715.9+/-330.58 ng/mL, p=0.015) between those with and without colonic polyps. CONCLUSION: These results suggest that screening colonoscopy should be recommended in acromegalic patients who are more than 40 year-old, have long disease duration or have high serum IGF-1 level.
Acromegaly ; Adenomatous Polyps ; Adult ; Classification ; Colon* ; Colonic Polyps* ; Colonoscopy ; Diagnosis ; Humans ; Insulin-Like Growth Factor I ; Mass Screening ; Prevalence*

BACKGROUND: The aim of the present study was to determine the population-based prevalence of diabetes mellitus (DM) and prediabetes in a rural district of Daegu City, Korea. METHODS: Between August and November 2003, a community-based health survey of adults aged 20 years and older was performed in the rural district of Dalseong-gun in Daegu City. A total of 1,806 of all eligible individuals agreed to participate. Fasting plasma glucose was measured in all participants. Two hour oral glucose tolerance was measured in the 1,773 participants for whom there was neither an established diagnosis of DM nor evidence of DM according to fasting glucose levels. The prevalence of DM and prediabetes was determined according to the 2003 criteria of the American Diabetes Association. Subjects with prediabetes were classified into one of three categories of glucose intolerance: isolated impaired fasting glucose (IFG); isolated impaired glucose tolerance (IGT); or combined IFG and IGT. RESULTS: The prevalence of DM was 12.2%. The highest prevalence rates were observed in subjects in their seventies. A total of 34.7% of all subjects who were assigned a diagnosis of DM in the present study had not been diagnosed previously. The prevalence of prediabetes was 22.7%. The highest prevalence rates were observed in subjects in their fifties. CONCLUSION: The present study identified prevalence rates of 12.2% for DM (age-standardized prevalence rate [ASR], 6.8%), and 22.7% for prediabetes (ASR 18.5%). These results emphasize the need for community health promotion strategies to prevent or delay the onset of DM in individuals with prediabetes.
Adult ; Aged ; Diabetes Mellitus ; Fasting ; Glucose ; Glucose Tolerance Test ; Health Promotion ; Health Surveys ; Humans ; Korea ; Plasma ; Prediabetic State ; Prevalence

BACKGROUND: Thyroid nodules are commonly encountered in clinical practice and a p revalence of general population is 19~67% by ultrasonography. We made a study to investigate clinical characteristics, malignancy ratio of thyroid incidentalomas and predicting factors for diagnosis of malignancy, to provide recommendation for evaluation. METHODS: We retrospectively evaluated the medical records of 320 patients who visited Kyungpook National University Hospital from July 2001 to December 2003 with non palpable thyroid nodules. We reviewed physical examination, ultrasonographic findings, laboratory findings, histology of thyroid nodules and did statististic analysis to examine relationship to malignancy. RESULTS: 52 patients revealed papillary carcinomas and malignancy rate whin incidentalomas is 9.3%. Sonographic findings of solid structure, hypoechogenecity, punctate calcification, ill defined margin, irregular shape showed meaningful diagnostic value for malignancy. CONCLUSIONS: Combination of meaningful sonographic findings increased possibility of maliganancy and require active mangements including recurrent fine needle aspiration and surgery if needed.
Biopsy, Fine-Needle ; Carcinoma, Papillary ; Diagnosis ; Gyeongsangbuk-do ; Humans ; Medical Records ; Physical Examination ; Retrospective Studies ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography

Silicone fluid(polydimethylsiloxane) is widely used in breast augmentation and other cosmetic procedures because of little incidence of complications and low mortality rate. However, local reaction following silicone injections can be occurred sometimes leading to serious complications. Especially, illicit silicone injections have resulted in severe reactions within the pulmonary area, and some have resulted in acute respiratory distress syndrome subsequently. We experienced a case of acute respiratory distress syndrome induced by subcutaneous injections of silicone at vaginal wall. The patients was 39-year-old, previously healthy woman who had complained of dyspnea related to silicone injection at vaginal wall. Chest X-ray and chest CT scan show diffuse air consolidation with ground glass opacities and perfusion lung scan revealed likelihood of pulmonary embolism as showing multiple perfusion defects. We report a case of acute respiratory distress syndrome after silicone injection with review of literature.
Adult ; Breast ; Dyspnea ; Female ; Glass ; Humans ; Incidence ; Injections, Subcutaneous ; Lung ; Mortality ; Perfusion ; Pulmonary Embolism* ; Respiratory Distress Syndrome, Adult* ; Silicones* ; Thorax ; Tomography, X-Ray Computed

Paraganglioma is an extraadrenal pheochromocytoma originating from chromaffin cells distributed in the sympathetic nervous systems. Functioning extraadrenal paragangliomas represent more than 10% of all pheochromocytomas, and seems to be highly malignant tumor in comparison to intraadrenal pheochromocytomas. Recently, we experienced a case of a paraganglioma in the posterior mediastinum. A 32-year-old woman was admitted to hospital due to dyspnea on exertion, and intractable hypertension. A chest X-ray showed a well-defined mass density on the right cardiac border, and biochemical studies showed characteristic findings of pheochromocytoma. A solitary pheochromocytoma was located in the posterior mediastinum using 131I-MIBG scintigraphy. The clinical manifestations, including hypertension and dyspnea were improved after operation.
Adult ; Chromaffin Cells ; Dyspnea ; Female ; Humans ; Hypertension ; Mediastinum* ; Paraganglioma* ; Pheochromocytoma ; Radionuclide Imaging ; Sympathetic Nervous System ; Thorax

Acute adrenal insufficiency may result from adrenal crisis, hemorrhagic destruction, or the rapid withdrawal of steroids from patient with chronic steroid medication, congenital adrenal hyperplasia or those on other drugs. Acute hemorrhagic destruction of both adrenal glands can occur due to infection, trauma, anticoagulant therapy, antiphospholipid syndrome or a coagulation disorder. However, there have been no reports on acute hemorrhagic adrenal insufficiency due to the Ebstein-Barr virus (EBV). Herein, a case of acute adrenal insufficiency, with bilateral adrenal hemorrhagic infarction, is reported in a patient with asymptomatic chronic adrenal insufficiency. A 42-year-old man presented with general weakness, weight loss and hyperpigmentation of several months duration. He suffered from a sore throat, general myalgia and a headache on admission. The laboratory findings were lymphocytosis, positive EBV IgM antibody, low cortisol level and a high level of adrenocorticotropic hormone (ACTH). Adrenocortical autoantibody and PCR for Mycobacterium tuberculosis showed negative findings. The serologic findings for CMV and HIV were negative. Fine needle aspiration of the adrenal gland revealed a hemorrhagic infarction and positive staining for the anti-EBV antibody. Acute adrenal insufficiency was then diagnosed with a bilateral adrenal hemorrhagic infarction due to the EBV infection in the patient, also with asymptomatic chronic adrenal insufficiency. This is the first case of acute adrenal insufficiency with bilateral hemorrhagic infarction, due to an EBV infection
Adrenal Glands ; Adrenal Hyperplasia, Congenital ; Adrenal Insufficiency* ; Adrenocorticotropic Hormone ; Adult ; Antiphospholipid Syndrome ; Biopsy, Fine-Needle ; Epstein-Barr Virus Infections ; Headache ; Herpesvirus 4, Human ; HIV ; Humans ; Hydrocortisone ; Hyperpigmentation ; Immunoglobulin M ; Infarction* ; Lymphocytosis ; Myalgia ; Mycobacterium tuberculosis ; Pharyngitis ; Polymerase Chain Reaction ; Steroids ; Weight Loss

Background: Korea recently established 70 emergency medical service areas. However, there are many concerns that medical resources for stroke could not be evenly distributed through the country. We aimed to compare the treatment quality and outcomes of acute stroke among the emergency medical service areas. Methods: This study analyzed the data of 28,800 patients admitted in 248 hospitals which participated in the 8th acute stroke quality assessment by Health Insurance Review and Assessment Service. Individual hospitals were regrouped into emergency service areas according to the address of the location. Assessment indicators and fatality were compared by the service areas. We defined the appropriate hospital by the performance of intravenous thrombolysis. Results: In seven service areas, there were no hospitals which received more than 10 stroke patients for 6 months. In nine service areas, there were no patients who underwent intravenous thrombolysis (IVT). Among 167 designated emergency medical centers, 50 hospitals (29.9%) responded that IVT was impossible 24 hours a day. There are 97 (39.1%) hospitals that meet the definitions of appropriate hospital. In 23 service areas (32.9%) had no appropriate or feasible hospitals. The fatality of service areas with stroke centers were 6.9% within 30 days and 15.6% within 1 year from stroke onset than those without stroke centers (7.7%, 16.9%, respectively). Conclusions There was a wide regional gap in the medical resource and the quality of treatments for acute stroke among emergency medical service areas in Korea. The poststroke fatality rate of the service areas which have stroke centers or appropriate hospitals were significantly low.