The internal biliary fistula between the gallbladder or bile duct and intestinal tract is a rare disease. Because symptoms and signs of biliary fistula are not specific, these patients are commonly investigated with computed tomography, endoscopic retrograde cholangiopancreatography (ERCP) and barium study. Among them, a cholecystogastric fistula is a very rare type of biliary fistula. We recently experienced a case of cholecystogastric fistula and transmigration of the gallstone to the stomach. A 53-year-old woman was transferred with the impression of gallbladder cancer. On evaluating the cause of right upper abdominal pain and nausea, we confirmed the cholecystogastric fistula with gastroscopy, upper GI series and ERCP. Cholecystectomy and the repair of the fistula was done.
Abdominal Pain ; Barium ; Bile Ducts ; Biliary Fistula ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Female ; Fistula* ; Gallbladder ; Gallbladder Neoplasms ; Gallstones* ; Gastroscopy ; Humans ; Middle Aged ; Nausea ; Rare Diseases ; Stomach

The use of totally implantable central venous access devices (chemoport) has increased with the development of chemotherapeutic agents in oncologic patients, especially with no venous access site. However, there can be various complications such as port site infection, thromboembolism, injury of central vein, fracture of catheter, and migration of catheter. We report a rare case of migration of catheter to right atrium due to the separation of the catheter from the chemoport.
Catheters ; Heart Atria ; Humans ; Thromboembolism ; Veins

Oral anticoagulants are used for prophylaxis or treatment of both arterial and venous thromboembolisms, and their use has increased with the increment of the aged population and cardiovascular disease. Oral anticoagulants, such as warfarin, are associated with a risk for bleeding, but small bowel necrosis by hemorrhage is a very rare complication of warfarin therapy. The combination of warfarin and an antiplatelet agent increase the risk of bleeding. A 70-year-old man with no prior symptoms was admitted to the emergency department with periumbilical pain. He had been taking warfarin and aspirin due to valve replacement therapy. He underwent an exploratory laparotomy due to sustained abdominal pain and fever. A macroscopic examination of the resected jejunum showed transmural hemorrhagic necrosis. We report a rare case of small bowel necrosis as a complication of warfarin therapy.
Abdominal Pain ; Aged ; Anticoagulants ; Aspirin ; Cardiovascular Diseases ; Emergencies ; Fever ; Hemorrhage ; Humans ; Jejunum ; Laparotomy ; Necrosis ; Thromboembolism ; Warfarin

Hepatic portal venous gas (HPVG) is a rare disease presenting as acute abdomen. There were first described in children with necrotizing enterocolitis in 1955. HPVG is caused by mesenteric ischemia but may have various etiologies. Predisposing factors that develop mesenteric ischemia include gastric ulcer disease, bowel obstruction, diverticulitis and sepsis. The presence of the air in the portal and mesenteric vein on radiographics has been associated with a mortality rate of more than 75% in earlier studies. Abdominal computed tomography has proven useful for detecting portomesenteric venous gas and pneumatosis intestinalis. We report a case of the patient with hepatic portal venous gas with pneumatosis intestinalis, which showed rapid progress of the disease and eventually died within 24 hours of admission.
Abdomen, Acute ; Child ; Diverticulitis ; Enterocolitis, Necrotizing ; Humans ; Ischemia ; Mesenteric Veins ; Portal Vein ; Rare Diseases ; Sepsis ; Stomach Ulcer

OBJECTIVES: To evaluate the Community-Based Participatory Research (CBPR) professional periodontal care program model for patients with hypertension and diabetes. METHODS: This descriptive case study included 151 participants of the professional periodontal care program. The CBPR-based professional periodontal care program consists of 5-steps: ‘Issue identification and prioritization’ (Step 1), ‘Strategy development’ (Step 2), ‘Entry into community’ (Step 3), ‘Implementation’ (Step 4), and ‘Transition’ (Step 5). Quantitative data were analyzed using frequency analysis, and descriptive data with PASW 23.0 (SPSS Inc., Chicago, IL, USA). The results of the Focus group interview (FGI) were classified as ‘general opinions regarding the program planning and operation receptiveness’, ‘sustainability’, ‘potential spread of the program’, and ‘improvement of program’. The interviews were qualitative research involving seven people. RESULTS: 1. Participants increased their interest in health and oral health by managing their hypertension, diabetes, and periodontal disease using community resources. Through this, healthy practices and improved awareness helped to prevent complications and manage periodontal diseases. 2. Community organizations actively cooperated, resulting in positive changes in oral health practices (increased registration of patients in education centers for hypertension and diabetes, and increased number of patients visiting the local dental clinic). In the future, it was positive to participate in the program continuously. CONCLUSIONS: The most important step is ‘Entry into community’, which has led to active participation and cooperation of community organizations and participants. Therefore, community organizations and strategy development should be discussed, and the role of community leaders should be emphasized to build cooperative relationships. In addition, participation in and collaboration with health-based projects should be achieved through a search of various community organizations.
Chronic Disease ; Community-Based Participatory Research ; Consumer Participation ; Cooperative Behavior ; Education ; Focus Groups ; Humans ; Hypertension* ; Oral Health ; Periodontal Diseases ; Qualitative Research

Postappendectomy bleeding is a rare and occasionally catastrophic phenomenon. Bleed-ing in the gastrointestinal tract may occur early or late. The cause of late bleeding included ulceration, vascular malformation or granuloma. We experienced a case of delayed appen-diceal stump ulceration and bleeding who underwent an appendectomy 1 year ago. The patient was admitted due to melena. A colonoscopy showed a well-circumscribed deep ulcer containing of silk suture material at the base of appendiceal stump. Biopsy revealed only granulation tissue with nonspecific inflammation. The silk was removed by biopsy forcep and sulfasalazine was tried. A repeat colonoscopy showed the complete ulcer heal-ing 3 months later. We report this case with a review of literatures.
Appendectomy* ; Biopsy ; Colonoscopy ; Gastrointestinal Tract ; Granulation Tissue ; Granuloma ; Hemorrhage* ; Humans ; Inflammation ; Melena ; Silk ; Sulfasalazine ; Surgical Instruments ; Sutures ; Ulcer* ; Vascular Malformations

The purpose of this study is to develop a systematic and efficient curriculum for the rehabilitation nurse specialist program. This research was carried out as a group work of 15 experts in order to share vanous opinions about the curriculum. and also through literature review. Articles. curriculums of other Clinical Nurse Specialist Programs. medical laws guidelines. as well as Clinical Nurse Specialist Program from the Korean Nurses Association were reviewed, and the issue was discussed throughly via group meetings. The developed cunicul urn is as follows: 1. Educational philosophy lies in the fact that the rehabilitation nurses support the patients to maximize their potential and functional level. so that they could maintain healthy state and re-adapt to changed environment. Furthermore the rehabilitation nurses are disposed of arbitrary decision power under their own responsibility. thus they take charge of we]fare and healthy environment of the local society through the patients (subjects) and local resources. 2. Educational goals are to train rehabilitation nurse specialist. who correspond to the social needs. so to say. those who have the know]edge and skills for nursing practice, education and research. 3. The curriculum consists of 37 credits, of which 24 credits are based on lectures and 13 credits based on clinical practice. General courses are 3 subjects (5 credits): nursing theory, nursing research. and laws/ethics, Mandatory courses are 8 subjects with 19 credits: advanced physical assessment, pharmacology, pathophysiology, issues in rehabilitation nursing, advanced rehabilitation nursing intervention I. advanced rehabilitation nursing intervention II. sports physiology. special rehabilitation nursing intervention. As for the clinical practice courses, assesment and evaluation for rehabilitation (64 hours), community and home based rehabilitation nursing(128 hours), hospital based rehabilitation nursing(l28 hours), institution based rehabilitation nursing(96 hours) would be treated. 4. Contents of the courses were developed to correspond with the courses' objectives and specific items. 5. Evaluation would be carried out both in the lecure and in the clinical practice. The knowledge and skills of the students would be measured to ensure full validity and credibility. However this developed curriculum should be continuously modified and updated in more desirable direction.
Curriculum* ; Education ; Equidae ; Group Processes ; Humans ; Jurisprudence ; Lectures ; Nurse Clinicians ; Nursing ; Nursing Research ; Nursing Theory ; Pharmacology ; Philosophy ; Physiology ; Rehabilitation Nursing ; Rehabilitation* ; Specialization* ; Sports

BACKGROUND: It is known that diabetes and stress are directly or indirectly related, and that it is important to evaluate stress in patients with diabetes. The relationship between Korean diabetics and diabetes-related stress has never been reported. The objective of this study was to develop a stress questionnaire suitable for use with Korean diabetics and to evaluate its utility. METHODS: This study subjects were 307 Korean diabetics, aged 40 to 74 years old, who visited the Department of Endocrinology and Metabolism at Gachon University Gil Hospital, Yeungnam University Medical Center, and Inha University Hospital in Korea between March 2006 and February 2008. We developed a Korean version of Polonsky's Problem Areas in Diabetes (PAID) stress questionnaire (PAID-K) and used it to assess degrees of stress in our sample of Korean patients. We evaluated the utility of the questionnaire and analyzed the relationships between clinical characteristics of the study subjects and degrees of stress. RESULTS: Cronbach's alpha for PAID-K was 0.95, and PAID-K scores were significantly correlated with Hypoglycemia Fear Survey scores (r=0.44, P<0.05) and State Trait Anxiety Inventory-6 scores (r=0.21, P<0.05). PAID-K scores were significantly higher in patients with longer durations of diabetes, patients using insulin, and female patients (P=0.02, P=0.038, and P=0.001, respectively). The score also tended to increase as HbA1c levels increased, except for very high HbA1c levels (above 11%) (P for trend<0.05). CONCLUSION: We developed the PAID-K questionnaire and demonstrated its utility to evaluate levels of stress in diabetic patients in Korea.
Academic Medical Centers ; Aged ; Anxiety ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Endocrinology ; Female ; Humans ; Hypoglycemia ; Insulin ; Korea ; Stress, Psychological ; Surveys and Questionnaires

PURPOSE: Mycophenolic acid (MPA), the active metabolite of mycophenolate mofetil (MMF), is a potent inhibitor of inosine-monophosphate dehydrogenase (IMPDH), a new immunosuppressive drug used. It was reported that MPA protected neurons after excitotoxic injury, induced apoptosis in microglial cells. However, the effects of MPA on hypoxic-ischemic (HI) brain injury has not been yet evaluated. Therefore, we examined whether MPA could be neuroprotective in perinatal HI brain injury using Rice-Vannucci model (in vivo) and in rat brain cortical cell culture induced by hypoxia (in vitro). METHODS: Cortical cells were cultured using a 18-day-pregnant Sprague-Dawley (SD) rats and incubated in 1% O2 incubator for hypoxia. MPA (10 microgram/mL) before or after a HI insult was treated. Seven-day-old SD rat pups were subjected to left carotid occlusion followed by 2 hours of hypoxic exposure (8% O2). MPA (10 mg/kg) before or after a HI insult were administrated intraperitoneally. Apoptosis was measured using western blot and real-time PCR for Bcl-2, Bax, caspase-3. RESULTS: H&E stain revealed increased brain volume in the MPA-treated group in vivo animal model of neonatal HI brain injury. Western blot and real-time PCR showed the expression of caspase-3 and Bax/Bcl-2 were decreased in the MPA-treated group In in vitro and in vivo model of perinatal HI brain injury, CONCLUSION: These results may suggest that the administration of MPA before HI insult could significantly protect against perinatal HI brain injury via anti-apoptotic mechanisms, which offers the possibility of MPA application for the treatment of neonatal HI encephalopathy.
Animals ; Anoxia ; Apoptosis ; Blotting, Western ; Brain Injuries* ; Brain* ; Caspase 3 ; Cell Culture Techniques ; Incubators ; Models, Animal ; Mycophenolic Acid* ; Neurons ; Neuroprotective Agents* ; Oxidoreductases ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction