A 54-year-old male patient was seen in clinic for ocular pain and decreased vision in the right eye with duration of two days. He underwent a cataract operation for his right eye 12 years ago, then a sclera-fixated secondary intraocular implantation and pars plana vitrectomy three years ago due to intraocular lens dislocation. At the initial visit, his visual acuity was restricted to the perception of hand motion. An edematous cornea, cells, flare with hypopyon, and exposed suture material at were observed at the six o'clock direction by slit lamp. Vitreous opacity was noted from B-scan ultrasonography. The patient was diagnosed with late-onset endophthalmitis and an intravitreal cocktail injection was done. On the next day, the hypopyon was aggravated, and therefore a pars plana vitrectomy was performed. A vitreous culture tested positive for Citrobacter koseri. After 12 weeks, the best corrected visual acuity of the right eye improved to 0.7 and a fundus examination revealed a relatively normal optic disc and retinal vasculature. We herein report the first case of endophthalmitis caused by Citrobacter koseri in Korea. Exposed suture material was suspected as the source of infection in this case and prompt surgical intervention resulted in a relatively good visual outcome.
Anti-Bacterial Agents/administration & dosage ; Cataract Extraction/adverse effects ; Citrobacter koseri/*isolation & purification ; Diagnosis, Differential ; Endophthalmitis/diagnosis/*microbiology/therapy ; Enterobacteriaceae Infections/diagnosis/*microbiology/therapy ; Eye Infections, Bacterial/diagnosis/*microbiology/therapy ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Lens Implantation, Intraocular/*adverse effects ; Male ; Microscopy, Acoustic ; Middle Aged ; Surgical Wound Infection/diagnosis/*microbiology/therapy ; Sutures/adverse effects/microbiology ; Visual Acuity ; Vitrectomy ; Vitreous Body/*microbiology

PURPOSE: We studied the change of bronchial hyperresponsiveness(BHR) from childhood to early adulthood and to know the risk factors which influence on the persistence of BHR. METHODS: Seventy two atopic asthma children with nonspecific BHR to methacholine were observed for about 10 years, longitudinally. They were divided into 3 groups depend on the degree of BHR; no BHR group(A group), asymptomatic BHR group(B group), symptomatic BHR group(C group) and compared clinical and atopic findings, inflammation degree of airway, and environmental factors between the groups. RESULTS: In the group A, B, C, the number of subjects were, respectively, 15(20.8%), 19 (26.4%), 38(52.8%). The frequency of group C was higher in the subjects with more severe asthma symptoms and higher BHR at diagnosis. The positive rates of skin prick test to Dp, Df, and pets, serum total IgE, sputum eosinophils, sputum ECP at the time of follow-up were significantly higher in group C. The frequency of subjects with carpets/sofa/bed, pets at home and smokers at the time of follow-up were higher in group B, C. CONCLUSION: Significant number of childhood asthma showed persistent nonspecific BHR in early adulthood. The persistence of nonspecific BHR in early adulthood was related with severity of asthma at diagnosis, laboratory findings and environmental factors at follow up.
Asthma* ; Child ; Clinical Laboratory Techniques ; Diagnosis ; Eosinophils ; Follow-Up Studies* ; Humans ; Immunoglobulin E ; Inflammation ; Methacholine Chloride ; Risk Factors* ; Skin ; Sputum

Sarcoidosis is a multisystem disorder of unknown origin characterized by noncaseating granulomatous inflammation. This disorder has variable clinical course, ranging from benign self - limited recovery to life-long disability. Sarcoidosis is found worldwide; however, the incidence and clinical course of the disease vary among different ethnicity and geographic regions. Especially in Korea, sarcoidosis had been known as a very rare disease until the 1st and the 2nd nationwide surveys performed in 1993 and 1998 by the Korean Academy of Tuberculosis and Respiratory Diseases. Those surveys revealed gradually increasing incidence of biopsy-proven sarcoidosis in Korea (0.027/100,000 in 1993 to 0.125/100,000 in 1998), but still very rare, and the peak age was the 30's with a female predominance (64.6%). The respiratory symptom was the most common (42%) symptom and thoracic lesion including mediastinum was the most frequently (87%) involved organ. On the other hand, cardiac involvement of this disease was very rare (0.7%). In conclusion, sarcoidosis in Korea, is a still uncommon disorder, and clinical manifestations were similar to those of western countries. Additional nationwide survey should be performed and maintained in order to investigate the correct incidence and the course of clinical manifestations of sarcoidosis in near future.
Female ; Hand ; Humans ; Incidence ; Inflammation ; Korea ; Mediastinum ; Rare Diseases ; Sarcoidosis ; Tuberculosis

PURPOSE: The purpose of this study was to describe role conflict and job satisfaction of Neurosurgery Clinical Nurse Specialist(NCNS) and to identify associated factors. METHOD: The target populations was 77 NCNSs from 30 general hospitals. Data were collected with self-administered questionnaires and analyzed using t-test and ANOVA. RESULTS: The overall mean scores of role conflict and job satisfaction were 3.60(+/-0.54) and 3.04(+/-0.46) respectively. Significant variables affecting role conflict were the working period as NCNS, the number of colleague NCNSs in working hospital, and assignment of prescription rights. The significant variable affecting job satisfaction was assignment of prescription rights. There was no statistically significant correlation between job and role conflict. CONCLUSION: The variable effecting both role conflict and job satisfaction was the extent of prescription rights. In order to improve the quality of patient care and to protect Neurosurgery Nurse Clinical Specialist, the enactment of law on prescription practice is needed.
Health Services Needs and Demand ; Hospitals, General ; Human Rights ; Humans ; Job Satisfaction* ; Jurisprudence ; Neurosurgery* ; Nurse Clinicians* ; Patient Care ; Prescriptions ; Specialization ; Surveys and Questionnaires

Pleural involvement in paragonimiasis is relatively common, either unilateral or bilateral, and may occur without pulmonary parenchymal infiltrates. Common radiologic findings of pleural paragonimiasis are pleural effusion, pneumothorax, hydropneumothorax, empyema and pleural thickening. However, pleural calcification as a manifestation of paragonimiasis is a rare condition. We report two cases of paragonimiasis manifested only as pleural calcifications which were confirmed pathologically.
Empyema ; Hydropneumothorax ; Paragonimiasis* ; Pleural Effusion ; Pneumothorax

We managed three cases of anesthesia for living related liver transplantation from December 1994 to July 1995. Donors were recipient's parents and two of them were 35-year old man, the other was 25-year-old woman. The recipients were suffered from congenital liver diseases (two of them were diagnosed as biliary atresia and the other Byler's disease). They had presented severe jaundice and cholangitis and their mean age & body weight were 15 +/- 4.9 months and 8.6 +/- 1.22 kg, respectively. Average duration of anesthesia was about 15 hours, and anhepatic time was 140 minutes, 80 m inutes and 50 minutes, respectively. Careful attention was paid to body temperature, serum potassium, ionized calcium, blood coagulation function, as well as to general condition and respiratory function. Hemodynamic value was relatively stable through out the operation and postoperative mechanical ventilatory support was required for about 3 days.
Adult ; Anesthesia ; Biliary Atresia ; Blood Coagulation ; Body Temperature ; Body Weight ; Calcium ; Child* ; Cholangitis ; Female ; Hemodynamics ; Humans ; Jaundice ; Liver Diseases ; Liver Transplantation* ; Liver* ; Parents ; Potassium ; Tissue Donors*

PURPOSE: This study was done to provide fundamental data to develop a simulation application working practice module and to develop a strategy that would improve team efficacy of students, as well as interpersonal understanding, and proactivity in problem solving after using the team based learning simulation. METHODS: The participants were students in fourth year in C University and they participated in the simulation learning for 8 weeks from October to December 2010. The variables of team efficacy, interpersonal understanding, and proactivity in problem solving were measured and data were analyzed using SPSS WIN 17.0 program. RESULTS: After applying the team based simulation learning, students' team efficacy, interpersonal understanding, and proactivity in problem solving improved significantly. CONCLUSION: The results indicate that the simulation module in this study gave the students experience in providing available and safe nursing care under conditions similar to reality and also underlined the importance of team competency for student nurses in caring for patients.
Education, Nursing ; Humans ; Learning ; Nursing Care ; Nursing, Team ; Patient Simulation ; Problem Solving

Gastric cancer is the most common gastrointestinal malignancy in Korea. Identification and evaluation ofgastric mass lesions and regional-distant metastases by abdominal CT scan are important for the treatment planningand prognostic implications of gastric cancer patients. Author reviewed CT scan are important for the treatemntplaning and prognostic implications of gastric cancer patients. Author reviewed CT scan of 61 cases of pathologyproven gastric cancer, retrospectively, for recent 20 months from July 1983 to Feb. 1985 at department ofradiology, Korea University, Hae Wha Hospital. The results were as follows: 1. There were 50 cases of advanced adenocarcinoma, 8 cases of early gastric cancer, 2 cases of leiomyosarcoma, and 1 case of lymphoma in total 61cases. 2. The sex ratio of male to female was 2:1. Age distribution was from 24 to 75 year old and peak incidencewas in 6th decade. 3. The most frequent site of involvement with gastric cancer was gastric antrum in 51%. 4. 48of the 50 patients with advanced gastric adenocarcinoma(96%) had a wall thickness greater than 1 cm, and all of 8cases of early gastric cancer had a wall thickness less than 1 cm. Regional lymph node tumor infiltration wasfound in 100% of gastric wall thickness greater than 2.0cm, in 64% of cases of 1.5 to 2.0cm, in 50% of cases of1.9 to 1.5cm, and 12.5% of cases of less than 1.0cm. 5. In a comparison of enlargement of reginal lymph node by CTscan to tumor infiltration of regional lymph node by histology, senitivity was 52%, specificity was 87%, and reliability was 66%. 6. The structures involved by distant metastases of these cases were the retroperitoneallymph node in 15, liver in 8, and pancrease in 3. 7. The diagnostic accuracy of CT staging was considered about68% by correlation of the surgical and histological findings. 8. The CT scan is one of the accurate and simpletool for evaluation of size, shape, extent, as well as distant metastases in the cases of gastric malignancies.
Adenocarcinoma ; Age Distribution ; Female ; Humans ; Korea ; Leiomyosarcoma ; Liver ; Lymph Nodes ; Lymphoma ; Male ; Neoplasm Metastasis ; Pancreas ; Pancrelipase ; Pyloric Antrum ; Retrospective Studies ; Sensitivity and Specificity ; Sex Ratio ; Stomach Neoplasms ; Tomography, X-Ray Computed

Diagnostic radiologic studies for angiosarcoma are usually non-specific, but selective angiography is notablyexceptional, and there had been a few reports of CT or US featurs of hepatic or splenic angiosarcoma. We recentlyexperienced a case of hepatic and splenic angiosarcoma demonstrated by CT, US and selective angiogram in34-year0old man.
Angiography ; Hemangiosarcoma

Purpose: This report describes a case of recurrent ophthalmoplegia associated with hyperhomocysteinemia due to methylenetetrahydrofolate reductase (MTHFR) gene polymorphism.Case summary: A 40‐year‐old healthy man presented with acute diplopia. He had a history of diplopia due to left sixth nerve palsy 2 years ago. Prism and alternate cover tests revealed left hypertropia in the primary position. Examination of ductions and versions showed mild elevation of the left eye on adduction. Brain and orbit magnetic resonance imaging were normal. Laboratory studies revealed an elevated level of erythrocyte sedimentation rate (ESR) and homocysteine. A diagnosis of left fourth nerve palsy associated with hyperhomocysteinemia was made. Symptoms were completely resolved within 2 weeks. Two years later, the patient again had diplopia associated with esotropia and limited abduction of the right eye. ESR and homocysteine level were normal. Analysis for MTHFR gene polymorphisms, which contribute to variable hyperhomocysteinemia, revealed 677TT homozygote variant. A diagnosis of recurrent paralytic strabismus associated with hyperhomocysteinemia, caused by MTHFR gene polymorphism, was made. Symptoms resolved within 1 month, and the patient did not have any further recurrence in 6 months. Conclusions Patients with hyperhomocysteinemia may present with ophthalmoplegia. An analysis for MTHFR gene polymorphisms is needed to diagnose hyperhomocysteinemia.