The high incidence antigert Jr" was first identified in 1970 by Stroup and Macllroy. Anti-Jr~ was immune antibodies developed by transfusion or pregnancy and occasionally cause hemolytic disease of the newborn and transfusion reaction, but these usually mild. We are reporting the first case of anti-Jra in Korea, which was identified in pregnant woman with transfusion history. The 35 year old pregnant woman(G6P4L1D3A1) admitted to treat for incompetent internal os of cervix on department of Obstetrics and Gynecology. Prenatal irregular antibody screening was negative. One unit of RBC was transfused at 21 gestational weeks for correction of anemia. One week later, irregular antibody was detected in her serum. The antibody reacted best by indirect antiglobulin test and panagglutinated all identified cells. The titer was 1 : 8. The antibody was identified as anti-Jr by Dr. Osaka Red Cross Center. Her phenotype of Jra was Jr(a-), but there was no Jr(a-) person in her family. She might have anti-Jra in her serum with undetectable level due to multiple pregnancies. In this case, the development of anti-Jr was stimulated by one unit of RBC transfusion with anamnestic reaction. The titer of anti-Jr was gradually reduced during pregnant period. She delivered at 37 gestational weeks by cesarian section. The baby was clinically well at birth and typed as Jr(a+).
Adult ; Anemia ; Antibodies ; Blood Group Incompatibility ; Cervix Uteri ; Coombs Test ; Female ; Gynecology ; Humans ; Incidence ; Infant, Newborn ; Korea ; Mass Screening ; Obstetrics ; Parturition ; Phenotype ; Pregnancy ; Pregnancy, Multiple ; Pregnant Women* ; Red Cross

No abstract available.
Candidemia* ; Humans

PURPOSE: The purpose of this study was to identify the factors influencing suicidal ideation in older adults with osteoarthritis. METHODS: Data was collected by questionnaires using face-to-face interviews from 87 outpatients selected at a private hospital. The data was analyzed using SPSS/WIN 12.0. RESULTS: The mean scores of disability, depression and suicidal ideation were 58.5, 18.1 and 8.3 respectively. There were significant differences in suicidal ideation according to socio-demographic factors such as education, present job, marital status, residence with, economic status, difference in caregiver. Depression was a significant predictor of suicidal ideation (F=51.15, p<.001). CONCLUSION: Based on the findings of this study, to prevent suicidal ideation for older adults with osteoarthritis, nursing intervention program should include psychological care for depression as well as physical care for disability reduction.
Adult* ; Caregivers ; Depression ; Education ; Hospitals, Private ; Humans ; Marital Status ; Nursing ; Osteoarthritis* ; Outpatients ; Questionnaires ; Suicidal Ideation*

No abstract available.
Scrub Typhus* ; Seoul*

PURPOSE: The purpose of this study is to investigate the reliability and validity of new clinical performance examination (CPX) for assessing clinical reasoning skills and evaluating clinical reasoning ability of the students. METHODS: Third-year medical school students (n=313) in Busan-Gyeongnam consortium in 2014 were included in the study. One of 12 stations was developed to assess clinical reasoning abilities. The scenario and checklists of the station were revised by six experts. Chief complaint of the case was rhinorrhea, accompanied by fever, headache, and vomiting. Checklists focused on identifying of the main problem and systematic approach to the problem. Students interviewed the patient and recorded subjective and objective findings, assessments, plans (SOAP) note for 15 minutes. Two professors assessed students simultaneously. We performed statistical analysis on their scores and survey. RESULTS: The Cronbach α of subject station was 0.878 and Cohen κ coefficient between graders was 0.785. Students agreed on CPX as an adequate tool to evaluate students' performance, but some graders argued that the CPX failed to secure its validity due to their lack of understanding the case. One hundred eight students (34.5%) identified essential problem early and only 58 (18.5%) performed systematic history taking and physical examination. One hundred seventy-three of them (55.3%) communicated correct diagnosis with the patient. Most of them had trouble in writing SOAP notes. CONCLUSION: To gain reliability and validity, interrater agreement should be secured. Students' clinical reasoning skills were not enough. Students need to be trained on problem identification, reasoning skills and accurate record-keeping.
Checklist ; *Clinical Competence ; Communication ; Comprehension ; *Education, Medical, Undergraduate ; Educational Measurement/*standards ; Humans ; Medical History Taking ; Medical Records ; Observer Variation ; Physical Examination ; Physician-Patient Relations ; *Problem-Based Learning ; Reproducibility of Results ; Republic of Korea ; *Schools, Medical ; *Students, Medical ; Surveys and Questionnaires ; *Thinking ; Universities

PURPOSE: Reconstruction of full-thickness defects of the nasal ala has always been a challenge. Local flaps can be used easily, and good result can be achieved when it is indicated. But local flaps often result in facial scars and bulky ala that require secondary revisions. Composite auricular chondrocutaneous graft may matches nasal alae well in terms of contour, color and texture, however, the size of composite graft is limited. We performed free vascularized helical root flaps for reconstruction of nasal ala. METHODS: Bilateral ala was excised and the defects were reconstructed with a chondrocutaneous free helical root flap. Each side of ala was reconstructed in 3 months interval. Superficial temporal vessels of vascularized helical root flap were anastomosed to facial vessels. Great saphenous vein was used for interpositional vascular graft. RESULTS: Flaps survived successfully. The contour, texture and color match were satisfactory. Functional problem of nasal obstruction caused by scar stenosis of nostrils was also resolved. CONCLUSION: The free vascularized helical root flap is a reliable method in reconstruction of nasal alar defects. The donor deformity was minimal.
Cicatrix ; Congenital Abnormalities ; Constriction, Pathologic ; Humans ; Nasal Obstruction ; Saphenous Vein ; Succinates ; Tissue Donors ; Transplants

PURPOSE: Reconstruction of soft tissue defects of the foot often requires free-flap transfer. Free muscle flap transfer and skin grafts on the muscle has been an option for these defects. Here we present our experiences of foot reconstruction using an endoscopy-assisted free muscle flap harvest. METHODS: Using endoscopy-assisted free muscle flap harvests, four patients with soft tissue defects of the foot were treated with a free muscle flap and skin graft. The gracilis muscle was used for two patients and the rectus abdominis muscle for two. A single small transverse skin incision was placed on the lower abdomen for the rectus abdominis muscle. A small transverse skin incision on the proximal thigh was the only incision for harvesting the gracilis muscle flap. The small incisions were enough for the muscle flap to be pulled through. RESULTS: The flaps survived successfully in all cases. Contours were good from both functional and aesthetic aspects. No breakdowns or ulcerations of the flap developed during long-term follow-up. Resultant scars were short and relatively hidden. Functional morbidities such as abdominal bulging were not noted. CONCLUSION: Endoscopy-assisted harvest of muscle flap and transfer with skin graft is a good option for soft tissue defects of the foot. Morbidities of the donor site can be minimized with endoscopic flap harvest. This method is preferable for young patients who want a small donor site scar.
Abdomen ; Cicatrix ; Follow-Up Studies ; Foot ; Free Tissue Flaps ; Humans ; Muscles ; Rectus Abdominis ; Skin ; Thigh ; Tissue Donors ; Transplants ; Ulcer

Pneumonia and meningitis are the most frequent manifestations of pneumococcal infections. Pneumococcal spinal epidural abscesses have been rarely reported. Spinal epidural abscess by Streptococcus pneumoniae has been diagnosed among the patients with diabetes mellitus, alcoholism, corticosteroid therapy, intravenous drug use, chronic renal failure, AIDS, and history of spinal surgery. Recently, we experienced a case of pneumococcal spinal epidural abscess after spinal trauma. A 36-year-old male patient was admitted with back pain, fever, and paraplegia which occurred 5 days after the trauma. Spine MRI revealed spinal epidural abscess at the level from T2 to T9. He was treated with antimicrobial agents and surgical exploration for spinal epidural abscess. Pus culture grew S. pneumoniae which was susceptible to penicillin. Despite early surgical treatment, neurologic sequelae remained. Considering the high mortality and morbidity of pneumococcal spinal epidural abscess, early diagnosis and aggressive treatment including surgical intervention and antibiotics therapy should be implemented immediately.
Adult ; Alcoholism ; Anti-Bacterial Agents ; Anti-Infective Agents ; Back Pain ; Diabetes Mellitus ; Early Diagnosis ; Epidural Abscess* ; Fever ; Humans ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Male ; Meningitis ; Mortality ; Paraplegia ; Penicillins ; Pneumococcal Infections ; Pneumonia* ; Spine ; Streptococcus pneumoniae ; Suppuration

Pneumonia and meningitis are the most frequent manifestations of pneumococcal infections. Pneumococcal spinal epidural abscesses have been rarely reported. Spinal epidural abscess by Streptococcus pneumoniae has been diagnosed among the patients with diabetes mellitus, alcoholism, corticosteroid therapy, intravenous drug use, chronic renal failure, AIDS, and history of spinal surgery. Recently, we experienced a case of pneumococcal spinal epidural abscess after spinal trauma. A 36-year-old male patient was admitted with back pain, fever, and paraplegia which occurred 5 days after the trauma. Spine MRI revealed spinal epidural abscess at the level from T2 to T9. He was treated with antimicrobial agents and surgical exploration for spinal epidural abscess. Pus culture grew S. pneumoniae which was susceptible to penicillin. Despite early surgical treatment, neurologic sequelae remained. Considering the high mortality and morbidity of pneumococcal spinal epidural abscess, early diagnosis and aggressive treatment including surgical intervention and antibiotics therapy should be implemented immediately.
Adult ; Alcoholism ; Anti-Bacterial Agents ; Anti-Infective Agents ; Back Pain ; Diabetes Mellitus ; Early Diagnosis ; Epidural Abscess* ; Fever ; Humans ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Male ; Meningitis ; Mortality ; Paraplegia ; Penicillins ; Pneumococcal Infections ; Pneumonia* ; Spine ; Streptococcus pneumoniae ; Suppuration

Conventional direct surgical excision has been the most reliable method in the treatment of the benign tumor in the face but it inevitably leaves visible scar. Although studies of endoscopy-assisted excision in forehead and lateral brow masses representing a diverse group of lesions including lipoma, dermoid cyst and osteoma have been reported, the number of patients was limited. We treated 33 cases of various benign forehead masses with endoscopy-aided surgery from April, 1999 to July, 2004, and the age of the patients ranged from 5 to 54 years. Two slit incisions less than 1.5cm were placed behind the anterior hairline and tumor was excised after the subperiosteal pocket dissection. All masses were completely excised and pathologists confirmed that 19 cases were lipomas, 8 were dermoid cysts and 6 were osteomas. The size of the masses varied from 0.9x0.8cm to 5.0x4.0 cm. Complications such as tumor recurrence, scalp numbness and frontalis paralysis did not occur. There was no contour irregularity found in our series. Incision scars were hidden well posterior to the hairline, so patients were satisfied with the final results. After many experiences, we concluded that endoscopic excision is a simple and undoubtedly safe method, and provides excellent cosmesis in treating not only lipoma but also dermoid cyst and osteoma. It is an effective method for complete excision of various types of tumors in the forehead and brow.
Cicatrix ; Dermoid Cyst ; Endoscopy ; Forehead* ; Humans ; Hypesthesia ; Lipoma ; Osteoma ; Paralysis ; Recurrence ; Scalp