A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte* ; Pneumonia ; Pneumonia, Aspiration* ; Shock, Septic ; Spine ; Vomiting

No abstract available.
Dermatitis, Exfoliative ; Phototherapy ; Psoriasis

Allopurinol is widely used for chronic tophaceous gout as a uric acid lowering agent. Hypersensitivity to allopurinol occurrs in about 10% of patients, which limits the usage of allopurinol. The successful oral and intravenous desensitization of allopurinol has been reported worldwide since 1976. We recently experienced a 51-year-old male patient with gouty arthritis and hyperuricemia, who had previously experienced skin rash after allopurinol treatment. When allopurinol was retried, erythematous and foliative skin rash developed on entire body. Because allopurinol was essential in controlling hyperuricemia, the oral desensitization of allopurinol was tried. We report successful rapid oral allopurinol desensitization in the patient with chronic tophaceous gout, who exhibited exfoliative dermatitis as allopurinol hypersensitivity.
Allopurinol* ; Arthritis, Gouty ; Dermatitis, Exfoliative* ; Exanthema ; Gout ; Humans ; Hypersensitivity ; Hyperuricemia ; Male ; Middle Aged ; Uric Acid

BACKGROUND: Obesity is the most common nutritional disorder in Western society as well as in Korea. Obesity results from a combination of genetic, environmental, and behavioral factors. MATERIALS AND METHODS: In an attempt to investigate the association of obesity with its candidate genes, beta3 adrenergic receptor (beta3AR) and uncoupling protein 2 (UCP2), we analyzed polymorphisms of beta3AR Trp64Arg and UCP2 -866G/A by PCR-RFLP analysis and the obesity-related phenotypes, including body mass index (BMI), fasting glucose concentration, and plasma lipid profiles in 750 subjects. RESULTS: The Trp64Arg polymorphism in the beta3AR gene was not statistically associated with the BMI. The UCP2 -866G/A polymorphism was significantly higher in obese than in non-obese subjects (P<0.05). However, the UCP2 -866A/A polymorphism was higher in the non-obese subjects. CONCLUSION: These results suggest that the UCP2 -866G/A polymorphism might be more useful for the prediction of obesity and obesity-associated diseases in Korean patients than the beta3AR Trp64Arg polymorphism.
Body Mass Index* ; Child ; Fasting ; Glucose ; Humans ; Korea ; Nutrition Disorders ; Obesity ; Phenotype ; Plasma ; Receptors, Adrenergic

Background: Sleep disturbances are common in children and adolescents. However, they are rarely diagnosed and treated because parents, who often report the symptoms, may fail to notice the problems. Factors that can affect parent-child discrepancy include child’s diagnosis, parent’s occupation, and child’s sex. The current study retrospectively analyzed the effect of these factors on parent-child discrepancies of sleep disturbance scores. Methods: Data for sleep-related items in Youth Self-Report (YSR) and Child Behavior Checklist (CBCL) from 2014 to 2020 August in South Korea were collected from psychiatric outpatient clinics at Konkuk University Medical Center and Soonchunhyang University Hospital. Results: A three-way analysis of variance revealed main effect of diagnosis type and interaction between diagnosis type and mother’s occupation. Discrepancies were greater for mood and anxiety disorders compared to conduct-related disorder. Interaction effect revealed greater discrepancies in mood disorders for reports completed by working mothers compared to homemaker mothers. Conclusion The results of this study emphasize the need to explore with caution the selfreported sleep disturbances in adolescents, especially in those with mood disorders. The results also suggest that mother’s occupation should be taken into account when evaluating sleep reports of parents and adolescents.

Preoperative imatinib treatment for rectal gastrointestinal stromal tumors (GISTs) has been reported to reduce the tumor size and help preserve the anal sphincter function. On the other hand, preoperative imatinib may prevent an accurate assessment of the recurrent risk. The endoscopic resection of rectal GIST is rarely reported because of challenges that include securing the visual field and avoiding perforation. This paper reports a case in which a 5.5×4.0 cm sized rectal GIST was treated effectively by an endoscopic submucosal dissection (ESD) without preoperative imatinib. To date, the patient had no tumor recurrence or complications and is receiving adjuvant imatinib treatment. This case shows that ESD may be a good treatment option to preserve the anus in rectal GIST treatment.

Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.
Cardiomyopathies* ; Catecholamines ; Child, Preschool ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Hypertension ; Myocarditis ; Neuroblastoma*

PURPOSE: This study was conducted to analyze and clarify the meaning of the concept for relocation stress -focusing on patients transferred from an intensive care unit to a general ward. METHODS: This study used Walker and Avant's process of concept analysis. RESULTS: Relocation stress can be defined by these attributes as follows: 1) involuntary decision about relocation, 2) moving from a familiar and safe environment to an unfamiliar one, 3) broken relationship of safety and familiarity, 4) physiological and psychosocial change after relocation. The antecedents of relocation stress consisted of these facts: 1) preparation degrees of transfer from the intensive care unit to a general ward, 2) pertinence of the information related to the transfer process, 3) change of major caregivers, 4) change in numbers of monitoring devices, 5) change in the level of self-care. There are consequences occurring as a result of relocation stress: 1) decrease in patients' quality of life, 2) decrease in coping capacity, 3) loss of control. CONCLUSION: Relocation stress is a core concept in intensive nursing care. Using this concept will contribute to continuity of intensive nursing care.
Adaptation, Psychological ; Caregivers ; Concept Formation ; Humans ; *Intensive Care Units ; *Patient Transfer ; Patients' Rooms ; *Stress, Psychological

The Laugier-Hunziker syndrome is a rare syndrome characterized by macular hyperpigmentation of the lips and buccal mucosa associated with melanonychia. Onset is usually in adult life and no consistent systemic associations have been reported. Here we report a 39-year-old wonam with a longitudinal pigmented band on a finger and pigmented macules on the lip. We suggest that this is the first report in Korea and the syndrome is presumably more common than recognized.
Adult ; Fingers ; Humans ; Hyperpigmentation ; Korea ; Lip ; Mouth Mucosa

A statistical analysis of the diagnostic value for 244 aspiration biopsy cytology(ABC) among a total 1,043 cases from various sites was performed. ABC, using diagnostic terminology similar to that of a surgical pathology reports, was compared to the final tissue diagnosis. For the entire series, a sensitivity of 91.8%, a specificity of 99.3%, a positive predictive value of 98.9%, a negative predictive value of 94.8%, and an efficacy of the test of 96.3% were shown. There were 8 false negative and 1 false positive diagnosis. The diagnostic accuracy was 89.8%. Those results indicate that the ABC is a considerably highly accurate procedure that should be routinely employed.
Biopsy, Needle ; Child* ; Diagnosis ; Glomerulonephritis, IGA* ; Humans ; Immunoglobulin A* ; Intranuclear Inclusion Bodies ; Meningioma ; Pathology, Surgical ; Sensitivity and Specificity