We report an autopsy case of secondary hemochromatosis associated with multiple frequent blood transfusion for the treatment of aplastic anemia. A 23-year-old man had been diagnosed as having aplastic anemia at the age of 13. He received a whole blood transfusion, about 1280 ml, every month during the past 10 years. Recently he developed diabetes mellitus and a congestive heart failure. The autopsy revealed that multiple organs were affected by secondary hemochromatosis, including the liver, heart, pancreas, spleen, bone marrow, stomach, thyroid gland, adrenal glands, and testes. The lungs and liver showed gross and microscopic findings consistent with a congestive heart failure in addition to hemochromatosis. The details are presented. This is a case of rare secondary hemochromatosis occurring in a young man and presenting the classic histopathologic changes indistinguishable from those of primary hemochromatosis.
Adrenal Glands ; Anemia ; Anemia, Aplastic* ; Autopsy* ; Blood Transfusion ; Bone Marrow ; Diabetes Mellitus ; Heart ; Heart Failure ; Hemochromatosis* ; Humans ; Liver ; Lung ; Pancreas ; Spleen ; Stomach ; Testis ; Thyroid Gland ; Young Adult

PURPOSE: This methodological study was conducted to test the reliability and validity of an instrument that measures attitudes of advance directives (ADs) among nurses. METHODS: 1) Sixteen items related to attitudes in the English version of the Knowledge, Attitudinal, and Experiential Survey on Advance Directives (KAESAD) were forward/backward translated into Korean. 2) The content was validated by an expert panel (three nursing professors and eight hospice nursing specialists). 3) The preliminary 12 items were selected as a tool to assess the Korean version of Nurses' Attitudes towards Advance Directives (NAAD-K). 4) The instrument was validated by a survey (n=216). 5) It was confirmed to use the 12 items for the final version of the instrument. RESULTS: NAAD-K was shown to be valid in terms of factors, items and content. The three factors extracted from the factor analysis were named as follows: Caring for patients with an AD (factor 1), nurses' role in informing patients (factor 2) and patient right (factor 3). The three factors explained total variance 57.796%. Factor loadings of the 12 items ranged from 0.47 to 0.93. For the 12 items, Cronbach's alpha was 0.81, and Guttman split-half coefficient was 0.78. CONCLUSION: This instrument was identified to be applicable with satisfactory reliability and validity for further use in measuring nurses' attitudes towards ADs in hospice and palliative care.
Advance Directives ; Hospice and Palliative Care Nursing ; Hospices ; Humans ; Methods ; Nursing ; Palliative Care ; Patient Rights ; Reproducibility of Results

PURPOSE: This study was performed to measure nursing professionalism, organizational communication, and intent to stay, and investigate the relationship among these three variables in geriatric hospital nurses. METHODS: A cross-sectional survey was done with the participation of 195 nurses working at 23 geriatric hospitals in B city of Gyeongsangnam-do, Korea. Data were collected from January 19 to 25, 2018 using structured questionnaires and were analyzed using SPSS/WIN program. RESULTS: The geriatric hospital nurses' scores for nursing professionalism, organizational communication, and intent to stay were relatively lower than those of general hospital nurses. Each of these three variables was differently perceived according to participants' general characteristics but there was a positive correlation between them. The factors influencing intent to stay were organizational communication, age and through newspapers/advertising (one of motivations for working at geriatric hospitals). These three variables explained 47% of intent to stay. CONCLUSION: To increase intent to stay in geriatric hospital nurses, nursing or hospital managers must develop and apply programs that help improve nurses' professionalism and organizational communication. Especially geriatric hospital nursing managers should try to provide organizational communication enhancement programs for young and inexperienced nurses.
Cross-Sectional Studies ; Gyeongsangnam-do ; Hospitals, General ; Korea ; Nursing ; Professionalism

OBJECTIVE: The purpose of this study was to identify the factors that influence the consent of case management for suicide prevention. METHODS: This study included 232 suicide attempters from September 1, 2015 to August 31, 2016 at the Emergency Medical Center of Soonchunhyang University Bucheon Hospital, Korea. A retrospective chart analysis was performed using a chi-square test or Fisher exact test, as well as univariate and multivariate logistic regression analysis (R ver. 3.3.3). RESULTS: The positive factors affecting case management consent were direct face-to-face counseling with a case manager, patient's age, suicide attempt without alcohol, first suicide attempt, and no psychiatric history. In addition, suicide attempters who underwent follow-up case management were more likely to participate in outpatient mental health care. Through the case manager, continuous emotional support and encouragement were provided to the suicide attempt, which proved to be effective. CONCLUSION: This study emphasizes the importance of case management for suicide attempters visiting the emergency medical center and suggests that the cooperation of national and regional systems should be expanded to increase the case participation rate.
Case Management* ; Counseling ; Emergencies* ; Emergency Service, Hospital* ; Follow-Up Studies* ; Gyeonggi-do ; Humans ; Korea ; Logistic Models ; Mental Health ; Outpatients ; Retrospective Studies ; Suicide* ; Suicide, Attempted

PURPOSE: The aim of this study was to identify an adequate chest compression site with measurement of the sternal length of young Korean adults. METHODS: We measured the distance from the suprasternal notch to the lower end of the sternum by palpation and width of heel above the carpal bone end 1 cm (H1), 2 cm (H2) in young Korean adults. We also measured weight, height, and BMI of participants. We then compared correlation of each collected variant to sternal length and heel length. RESULTS: A total of 200 young adults (100 men, 100 women) were enrolled. In measurement of the mean sternal length (SL), no difference was observed between men (19.9 cm) and women (19.6 cm) (p<0.05). However, height, weight, and BMI showed positive correlation with SL (R2 value, BMI=6.7, height=9.2, weight=10.4). After participants were divided into four groups based on gender and mean height, we calculated mean H2 and SL/2 of each group. The mean H2 and SL/2 of the group composed of men above mean height was 8.5 cm and 10.2 cm. The same value for the group of men below mean height was 8.5 cm and 9.7 cm. The mean H2 and SL/2 of the group composed of women above mean height was 7.5 cm and 10.1 cm. The same values for the group of women below mean height were 7.3 cm and 9.6 cm. The mean SL/2 was always higher than the mean H2 in different height groups. CONCLUSION: Compression just above the lower end of the sternum by heel on the hand is appropriate in men. In contrast, when performing chest compression in women, chest compression at the level of the sternum away from the width of the index finger of the sternal end is recommended.
Adult* ; Cardiopulmonary Resuscitation ; Carpal Bones ; Female ; Fingers ; Hand ; Heel ; Humans ; Male ; Palpation ; Sternum ; Thorax* ; Young Adult

OBJECTIVE: This study aimed to analyze the expression pattern of glycogen synthase kinase 3β (GSK3β) and its phosphorylated forms, GSK3β phosphorylated at Ser9 (pS9GSK3β), and GSK3β phosphorylated at Tyr216 (pY216GSK3β), in cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC). METHODS: We performed immunohistochemical staining for GSK3β, pS9GSK3β, and pY216GSK3β in 64 SCC and 20 AC cases and compared their expression patterns between the 2 tumor types. RESULTS: Increased GSK3β and pS9GSK3β expression but decreased pY216GSK3β expression compared with that in the normal cervix were observed in both SCC and AC specimens. Specifically, the levels of GSK3β and pS9GSK3β were significantly increased in SCC and AC, respectively. GSK3β was localized in the nucleus and/or cytoplasm of SCC and AC cells. However, pS9GSK3β was predominantly localized in the membrane of AC cells, whereas it was present in the nucleus and/or cytoplasm of SCC cells. CONCLUSION: The results suggest that the phosphorylation status of GSK3β changes during cervical cancer development and the different expression levels and patterns of GSK3β and pS9GSK3β are associated with the specific histologic phenotype of cervical cancer.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Cervix Uteri ; Cytoplasm ; Epithelial Cells ; Female ; Glycogen Synthase Kinases ; Membranes ; Phenotype ; Phosphorylation ; Uterine Cervical Neoplasms

PURPOSE: The aim of this study un to determine factors that affect Emergency department (ED) Length of Stay (LOS) in patients with orbital wall fracture. METHODS: We retrospectively analyzed orbital fracture patients who visited our ED from January 1, 2012 to December 31, 2013. Patients'data, including sex, age, mechanism of injury, site of fracture, associated injury, physical finding, CT finding, and intra-ocular injuries were recorded. LOS was divided into three phases (Pre-consultation time, Consultation waiting time, Consultation time). We performed analysis to determine the factors associated with LOS. We also performed analysis to determine the factors associated with severe intraocular injury (SIOS). RESULTS: A total of 154 patients (160 eyes) were included. Orbital fractures were more frequent in males. The most common cause of orbital fracture was violence. LOS was 290.0 (IQR 200.0~465.0) min, pre-consultation time was 36.0 (IQR 22.0~61.0) min, consultation waiting time was 64.0 (IQR 34.0~128.0) min, and consultation time was 152.0 (IQR 87.0~245.0) min. Violence, alcohol consumption, consultation with plastic surgeon, and consultation with ophthalmologist showed association with prolonged LOS (p<0.001, p<0.001, p=0.04, p<0.001). Violence and alcohol consumption affected consultation waiting time (p<0.001, p<0.001) and consultation time (p=0.04, p<0.001). Consultation with a plastic surgeon and consultation with an ophthalmologist affected consultation time (p=0.03, p<0.001). Patients with symptoms including blindness, blurred vision, and visual field defect showed significant association with SIOS (Odd ratio=14.08). CONCLUSION: Violence, alcohol consumption, and consultations with specialists showed significant association with LOS.
Alcohol Drinking ; Blindness ; Emergency Service, Hospital* ; Humans ; Length of Stay* ; Male ; Orbit* ; Orbital Fractures ; Referral and Consultation ; Retrospective Studies ; Specialization ; United Nations ; Violence ; Visual Fields

Mycobacterium marinum is an uncommon cause of skin and soft-tissue infection. The diagnosis of M. marinum infection is often delayed when only a conventional tissue culture method is used. PCR-restriction fragment length polymorphism (RFLP) analysis using the novel region of the rpoB gene is now available for the rapid identification of Mycobacteria. We report a case of hand infection caused by M. marinum that was identified by PCR-RFLP analysis. The PCR-RFLP assay is a specific and rapid method for the identification of Mycobacteria that facilitates the early diagnosis of non-tuberculous Mycobacterium infection.
Early Diagnosis ; Hand ; Mycobacterium ; Mycobacterium Infections ; Mycobacterium marinum ; Skin ; Tenosynovitis

OBJECTIVE: Glycogen synthase kinase 3β (GSK3β) is a pluripotent protein kinase involved in the development of cancers through regulation of numerous oncogenic molecules. Cyclin D1, an important regulator of G1 to S phase transition in various cells, is one of target proteins that GSK3β regulate. Our objective was to assess the expression of GSK3β and cyclin D1 in cervical neoplasm of different histologic grades and to identify their correlation in cervical carcinogenesis. METHODS: Immunohistochemical analysis of GSK3β and cyclin D1 was performed in a total of 137 patients with 12 normal, 62 cervical intraepithelial neoplasia (CIN) (31 CIN1 and 31 CIN3) and 63 invasive cancers including 56 squamous cell carcinomas and 7 adenocarcinomas. RESULTS: The expression of GSK3β increased in parallel with the lesion grade, while that of cyclin D1 decreased with severity of the lesion (P<0.001). There was a significant inverse correlation between GSK3β and cyclin D1 expression in overall cervical neoplasia (Φ=-0.413, P<0.001). GSK3β expression was higher in squamous cell carcinoma than in adenocarcinoma (P=0.049). CONCLUSION: These results suggest that the expressional increase in GSK3β plays a role in cervical carcinogenesis and has inverse correlation with cyclin D1 expression in this process. In addition, GSK3β expression appears to be associated with the histologic type of cervical cancer, especially squamous cell carcinoma.
Adenocarcinoma ; Carcinogenesis* ; Carcinoma, Squamous Cell ; Cervical Intraepithelial Neoplasia ; Cyclin D1* ; Cyclins* ; Glycogen Synthase Kinases* ; Glycogen Synthase* ; Glycogen* ; Humans ; Immunohistochemistry ; Protein Kinases ; S Phase ; Uterine Cervical Neoplasms

A 2-year-old, female Pomeranian dog was referred for dyspnea. Thoracic radiographs revealed left-sided mediastinal shift, increased soft tissue opacity in the caudal aspect of left thorax with loss of the left diaphragmatic silhouette, and dorsal elevation of mediastinal structures and heart from the sternum by lung tissue. The left main bronchus was visualized as an air-bronchogram and observed to abruptly discontinue at the level of the 10th rib. Thoracic computed tomography (CT) revealed absence of the left lung parenchyma and left pulmonary vessels with a rudimentary left main bronchus. The case was congenital pulmonary aplasia diagnosed via radiography and CT.
Animals ; Bronchi ; Child, Preschool ; Diagnostic Imaging* ; Dogs* ; Dyspnea ; Female ; Heart ; Humans ; Lung ; Radiography ; Ribs ; Sternum ; Thorax