Neurofibromatosis, first clearly described by von Recklinghausen in 1882, is a dominantly inherited mesodermal and ectodermal dysplasia with a broad spectrum of clinical findings. Most common is the classical neurofibromatosis, which has three major features: (1) multiple neural tumors dispersed anywhere on or in the body; (2) numerous pigmented skin lesions, some of which are "cafe au lait" spots; and (3) pigmented iris hamartomas also called Lisch nodules. Other lesions sometimes seen in patients with von Recklinghausen's disease include congenital malformations of various types, vascular lesions, neurilemoma meningioma and other intracranial neoplasms, pheochromocytoma, medullary carcinoma of thyroid gland, neuroblastoma, ganglioneuroma and Wilms' tumor. Approximately 10% of the patients with neurofibromatosis have the gastrointestinal tract tumors as neurofibroma, ganglioneuroma and leiomyoma. Some of them show evidence of malignancy. Increased activity of the protein "nerve growth factor" in the sera of the patients with disseminated neurofibromatosis has been reported. We would like to report here two cases of von Recklinghausen's neurofibromatosis with involvement of the gastrointestinal tract.
Hamartoma ; Meningioma

Nowday, ionizing radiation is one of the methods eradicating the uterine cervical malignancy. However radiation alone or in combination with surgery have an effect on normal tissue as well as the malignant cells, and their changes have been well described in other countries. Unfortunately, the history of radiation modality for cancer treatment is relatively short and the reports about radiation induced changes are limited in our country. We evaluated the radiation-induced changes in cervico-vaginal smears of 107 uterine cervical cancer patients obtained from March, 1985 to October, 1987. Most patients had been received 5,400 Rads of external radiation and intracavitary radiation. Patient's age ranged from 30 to 67 years old. Of 107 cases, 24 cases were normal, 72 cases showed benign radiation changes, 7 cases revealed radiation dysplasia, and residual and recurrent carcinomas found in one and 3 cases, respectively. Cytoplasmic and nuclear enlargement were the most common and noted in 57 and 38 cases, respectively. Vacuolization and polychromasia of the cytoplasm were identified in 43 and 30 cases, respectively. The most common histiocytic change was multinucleation, which was found in about one third. The radiation changes of the cytoplasm and nuclear enlargement persisted for a long time after completion of radiation, however, nuclear degeneration and multinucleation gradually disappeared after 6 months. The inflammation in background prolonged for a long time but degeneration disappeared after 6 months. The biologic significance of post-radiation dysplasia could not evaluated because of short follow up period.

Nowday, ionizing radiation is one of the methods eradicating the uterine cervical malignancy. However radiation alone or in combination with surgery have an effect on normal tissue as well as the malignant cells, and their changes have been well described in other countries. Unfortunately, the history of radiation modality for cancer treatment is relatively short and the reports about radiation induced changes are limited in our country. We evaluated the radiation-induced changes in cervico-vaginal smears of 107 uterine cervical cancer patients obtained from March, 1985 to October, 1987. Most patients had been received 5,400 Rads of external radiation and intracavitary radiation. Patient's age ranged from 30 to 67 years old. Of 107 cases, 24 cases were normal, 72 cases showed benign radiation changes, 7 cases revealed radiation dysplasia, and residual and recurrent carcinomas found in one and 3 cases, respectively. Cytoplasmic and nuclear enlargement were the most common and noted in 57 and 38 cases, respectively. Vacuolization and polychromasia of the cytoplasm were identified in 43 and 30 cases, respectively. The most common histiocytic change was multinucleation, which was found in about one third. The radiation changes of the cytoplasm and nuclear enlargement persisted for a long time after completion of radiation, however, nuclear degeneration and multinucleation gradually disappeared after 6 months. The inflammation in background prolonged for a long time but degeneration disappeared after 6 months. The biologic significance of post-radiation dysplasia could not evaluated because of short follow up period.

PURPOSE: This study was done to explore the relationship between perceived patient safety culture and patient safety management activities among health personnel. METHODS: This study was a cross-sectional survey. Participants were 342 health personnel working in two tertiary hospitals. Self-administered questionnaires were used to collect data from a convenience sample of 254 nurses and 88 doctors. RESULTS: Scores on participants' perceived patient safety culture and patient safety management activities were just over the mean. There were significant differences in patient safety management activities by type of occupation, nurses' position, length of service, and work week. Doctors scored perceived patient safety culture and patient safety management activities significantly lower than nurses. In addition, perceived patient safety culture was significantly related to patient safety management activities. Factors which influence participants' patient safety management activities were communication, type of occupation, overall evaluation of patient safety, supervisor/manager, frequency with which events were reported, and nurse's position. CONCLUSION: Findings provide significant evidence that patient safety management activities are associated with perceived patient safety culture. Therefore, to build a positive safety culture, health personnel, especially doctors and general nurses need to visibly commit to patient safety management activities and be role models to ensure patient safety.
Cross-Sectional Studies ; Dietary Sucrose ; Health Personnel ; Humans ; Occupations ; Organizational Culture ; Patient Safety ; Surveys and Questionnaires ; Safety Management ; Tertiary Care Centers

Vascular transformation of lymph node sinuses is a rare condition and only isolated cases have been reported in the literature. Most lymph nodes with vascular transformation of sinuses are found in abdomen, and head and neck involvement is rare. It is characterized by the intrasinusoidal proliferation of endothelial cells forming a system of anastomosed channels filled with blood, and by an intrasinusoidal fibrous reaction. It is important to recognize that they may be a marker for the presence of any undetected malignant tumor. In this article, we report a rare case of vascular transformation of cervical lymph node sinuses with some reviews of the literature.
Abdomen ; Endothelial Cells ; Head ; Lymph Nodes* ; Neck

PURPOSE: Among the materials for cranioplasty, autogenous bone is ideal because it is less susceptible to infection and has lower rates of subsequent exposure. However, the procedure is technically demanding to perform and requires a donor site. Disadvantages further exist when the defect is large and there are attendant limitations in donor site. The authors present their experience with reconstruction of large skull defect using right-angled zigzag osteotomized outer table of autogenous calvarial bone, overcoming the limitation in donor site. METHODS: From 2000 to 2006, 9 patients were retrospectively reviewed, who had undergone reconstruction with right angled zigzag osteotomized outer table of autogenous calvarial bone. RESULTS: Aesthetically satisfactory skull shape was achieved. Major complications of infection, hematoma, plate exposure, and donor site complications of dural tear with bleeding, cerebrospinal fluid leak, and meningitis were not seen. One patient had delayed wound healing and was successfully managed conservatively. CONCLUSION: Autogenous bone is the material of choice for cranioplasty, especially in complicated cases. Right angled zigzag osteotomy is a useful method in reconstruction of large skull defects with less donor site morbidity.
Cerebrospinal Fluid ; Hematoma ; Hemorrhage ; Humans ; Meningitis ; Osteotomy* ; Retrospective Studies ; Skull* ; Tears ; Tissue Donors ; Wound Healing

Background: This study examined the relationship of infant feeding with anthropometric indices of children during their first six years of life relative to the Korean National Growth Charts (KNGC) and the World Health Organization Child Growth Standards (WHO-CGS). Methods: The study population consisted of 547,669 Korean infants and children who were 6 months-old to 6 years-old (born in 2008–2009) and participated in the National Health Screening Program for Infants and Children. Data on height, weight, and type of feeding during the first 6 months (exclusively breastfed [BF] vs. mixed- or formula-fed [FF]) were analyzed. Results: BF boys and girls were significantly shorter and lighter than FF counterparts from the age of 6 months to 4 years, but these differences were not significant after the age of 4 years. BF boys and girls only had significantly lower body mass index at the age of 2 years. Under the age of 2 years 6 months, and especially under the age of 1 year, BF boys and girls were significantly taller and heavier than the 50th percentile values of the 50th percentile value of the WHO-CGS. Conclusion In this study using large-scaled national data, Korean breastfed children are shorter and lighter by 3 years 6 months–4 years 6 months, but afterward, there is no significant difference from those who had mixed- or formula-feeding. Substantial disparities in the anthropometric indices of Korean infants under the age of 1 compared to KNCG and WHO-CGS were found, regardless of their infantile feeding types. Our results emphasize the importance of constructing a nationwide reference chart based on actual measurements of BF Korean infants.

Abdominal wall hernias are a common problem in patients treated with continuous peritoneal dialysis. Although most patients with abdominal wall hernia are asymptomatic, some patients may present with abdominal pain or, if the hernia is incarcerated or strangulated, with signs and symptoms of peritonitis. It is often difficult to differentiate abdominal catastrophe such as peritonitis secondary to strangulated hernia from CAPD peritonitis. Because their clinical manifestations are similar, several biochemical markers including amylase and lactic acid have been recently used as an indicator of abdominal catastrophe. We report a case of strangulated umbilical hernia with perforation misdiagnosed as CAPD peritonitis. The patient was operated 36 hours after the first inspection but expired due to overwhelming sepsis, 257 days after the admission to hospital.
Abdominal Pain ; Abdominal Wall ; Amylases ; Biomarkers ; Hernia ; Hernia, Umbilical* ; Humans ; Intestinal Perforation ; Lactic Acid ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Sepsis

Wegener's granulomatosis is an uncommon disease that is characterized by granulomatous necrotizing vasculitis affecting small vessels. It typically targets the upper and lower respiratory tract and the kidney, but gastrointestinal involvement is rare. A 41-year-old man who has been already diagnosed with Wegener's granulomatosis by nasal cavity biopsy was admitted with bloody diarrhea and high fever. He had discontinued taking the immunosuppressive medication. His colonoscopic finding revealed colitis and ulcer lesions which biopsies show vasculitis and ill-defined granuloma. Therefore he was treated with systemic steroid and improved dramatically.
Adult ; Biopsy ; Colitis* ; Diarrhea ; Fever ; Granuloma ; Humans ; Kidney ; Nasal Cavity ; Respiratory System ; Ulcer ; Vasculitis ; Wegener Granulomatosis*

The purpose of the present study was to examine a number of various times of Lipo-PGE1 administration in an attempt to determine the most effective time. In addition, this study examined the possible role of vascular endothelial growth factor(VEGF) on Lipo-PGE1 stimulation of a TRAM flap in the rat. Forty Sprague-Dawley rats were divided into 4 groups and a left inferior epigastric vessel pedicled TRAM flap, sized 5.0x3.5cm was created on the upper abdomen of each rat. Experimental groups included group 1(control): the flap was dissected and replaced, group 2(pharmacologic delay): Lipo-PGE1(0.5microgram) was given intraperitoneally for 5 days before elevation of flap daily, group 3(flap enhancement): Lipo- PGE1(0.5microgram) was given intraperitoneally for 5 days after flap elevation daily, group 4(pharmacologic delay and flap enhancement): Lipo-PGE1(0.5microgram) was given intraperitoneally for 5 days before elevation of flap then for 5 days after elevation of flap daily. On postoperative 5th day, we evaluated and compared the results of flap survival area, the number of blood vessel, and the VEGF expression using the western blot method. The results were as following: First, the mean percentage of the flap survival area of group II(63.9+/-12.6%), III(54.9+/-20.5%), IV(68.1+/- 18.2%) were higher than that of group I(28.7+/-15.2%) significantly(p<0.05). Second, the number of blood vessels were of group II(3.8+/-1.4), III(3.5+/-1.8), IV(4.0+/-1.5) were higher than that of group I(1.0+/-0.6) significantly(p<0.01). Third, the western blot method demonstrated a qualitatively greater amount of VEGF expression in the experimental groups. These results suggest that Lipo-PGE1 increased VEGF production and that Lipo-PGE1 may thereby enhance flap survival through VEGF production regardless of the time of Lipo-PGE1 administration.
Abdomen ; Alprostadil* ; Animals ; Blood Vessels ; Blotting, Western ; Rats* ; Rats, Sprague-Dawley ; Vascular Endothelial Growth Factor A