PURPOSE: The purpose of this study was to analyze and clarify the ambiguous concept of DNR, and to distinguish between DNR and euthanasia. METHOD: This study used the process of Walker & Avant's concept analysis. RESULT: The definable attributes of DNR were care for comfort, no further treatment and no CPR. The antecedents of DNR were the autonomy of patients and families feelings about death, the uselessness of treatment and the right to die with dignity. The process of the DNR decision should be documented and the antecedents of DNR also can be a basis for objective standards of DNR decision-making. The result of DNR was the acceptance of death by patients and families. CONCLUSION: DNR is decided and documented by the antecedents of DNR, and the result is a natural acceptance of death, the last process of human life. Hospice care should be activated and nurses must be patient's advocates and families' supporters in the process.
*Attitude to Death ; Decision Making ; Family ; Hospice Care ; Humans ; *Resuscitation Orders

PURPOSE: This study was conducted to comprehensively investigate nursing students' experience of their first encounter with death of a patient during clinical practice. METHODS: This study took place from January 27 through March 6, 2012 with eight female senior nursing students enrolled at Pusan National University located in Y city who have experienced patient death. We collected their experience of their first death encounter during their clinical rotation by asking, "What is your first experience of patient's death during the clinical practice?" Husserl's phenomenological approach was applied in this study. RESULTS: In this study, 17 themes, 15 clusters of themes and eight categories were derived. The categories included "Desire to avoid the reality of death", "Powerlessness", "Anticipation for recovery shifted to fear of death", "Various interpretations of death", "Limitations in their nursing practice", "Resentment of lack of nurses", "Longing to better understand death", and "Motivation for inner growth". CONCLUSION: Through their first encounter with death of a patient, nursing students experienced various emotions and viewed their role as hospice caregiver by projecting themselves as fully trained nurses in future. Participants considered terminal care as a part of nursing care. The result of this study indicates the need to include education of death in the nursing school curriculum.
Busan ; Caregivers ; Curriculum ; Education ; Female ; Hospices ; Humans ; Nursing Care ; Nursing* ; Schools, Nursing ; Students, Nursing ; Terminal Care

Familial benign pemphigus is a skin disease with recurrent blistering lesions, mainly in the neck and intertriginous areas. The course of the disease is characterized by spontaneous exacerbations and remissions. The many remedies for this disorder include topical and systemic glucocorticosteroids, and antibacterial and antimycotic agents. However, these therapies usually do not prolong the remission periods. Surgical treatments, such as skin graft, have been more successful. Laser treatment has reported to be effective in recurrent familial benign chronic phemphigus. Here we report a case of familial benign chronic phemphigus that was treated with carbin dioxide laser.
Blister ; Carbon Dioxide* ; Carbon* ; Lasers, Gas* ; Neck ; Pemphigus ; Pemphigus, Benign Familial* ; Skin ; Skin Diseases ; Transplants

Familial benign pemphigus is a skin disease with recurrent blistering lesions, mainly in the neck and intertriginous areas. The course of the disease is characterized by spontaneous exacerbations and remissions. The many remedies for this disorder include topical and systemic glucocorticosteroids, and antibacterial and antimycotic agents. However, these therapies usually do not prolong the remission periods. Surgical treatments, such as skin graft, have been more successful. Laser treatment has reported to be effective in recurrent familial benign chronic phemphigus. Here we report a case of familial benign chronic phemphigus that was treated with carbin dioxide laser.
Blister ; Carbon Dioxide* ; Carbon* ; Lasers, Gas* ; Neck ; Pemphigus ; Pemphigus, Benign Familial* ; Skin ; Skin Diseases ; Transplants

PURPOSE: We tried to define the etiology of the trigger thumb in children, to know the main symptom of the trigger thumb in children and to conclude the prophet age to operate without residual symptoms nor complications. MATERIALS AND METHODS: 1) 50 Children, 60 thumbs operated in our hospital (A1 pulley release after the age of 2) were included in this study. 2) In 7407 newborn babies born in our hospital, screening test were performed for detection of trigger thumb in nursery and also follow-up (180 days or more) for detection of trigger thumb was performed. RESULTS: 1) In 50 children underwent operation, only two (4%) had the deformity at the day of birth. All the babies (100%) had flexion contractures of the interphalangeal joint of the thumb. The nodule was found in 48 (80%) of 60 thumbs. The triggering, however, was found in only 16 thumbs (27%) . The patients underwent operation after the age of 4 (11 patients, 22%) had no complication nor residual symptom. 2) In the screening of 7407 newborn babies, nobody had flexion contractures of the thumb at the day of birth. CONCLUSIONS: 1) The main symptom of the trigger thumb in children was "flexion contracture", not "triggering". 2) The children operated after the age of 3 or 4 is expected to get good result.3) The trigger thumb in children is seemed to be "acquired" or "developmental" rather than "congenital".
Child* ; Congenital Abnormalities ; Contracture ; Follow-Up Studies ; Humans ; Infant, Newborn ; Joints ; Mass Screening ; Nurseries ; Parturition ; Thumb ; Trigger Finger Disorder*

Bony mallet finger is treated by from conservative management to various operative options. A lot of internal fixations except hook plate lead to cartilage damage and limitation of motion of distal interphalangeal joint. Thus we introduce Delta(Delta)-wire technique which can permit early joint motion and give strong compression force on the fracture fragment continuously.
Cartilage ; Fingers* ; Fracture Fixation ; Joints

Background/Aims: We conducted a nationwide population-based study to investigate incidence rates of colorectal and biliary cancers according to accompanying primary sclerosing cholangitis in Korean ulcerative colitis patients. Methods: We used the Health Insurance Review and Assessment claim database from January 2007 to April 2020. Standardized incidence ratios of colorectal and biliary cancers in ulcerative colitis patients were calculated. Results: Among 35,189 newly diagnosed ulcerative colitis patients, 1,224 patients were diagnosed with primary sclerosing cholangitis. During the study period, 122 and 52 patients were diagnosed with colorectal and biliary cancers, respectively. Incidences of colorectal cancer were not higher in ulcerative colitis patients than those in the general population (standardized incidence ratios, 0.83; 95% confidence interval, 0.69–0.99), regardless of accompanied primary sclerosing cholangitis (standardized incidence ratio, 0.73; 95% confidence interval, 0.24–1.71). While incidences of biliary cancer were not higher in ulcerative colitis patients than those in the general population (standardized incidence ratio, 1.14; 95% confidence interval, 0.80–1.58), these were much higher with accompanied primary sclerosing cholangitis (standardized incidence ratio, 10.07; 95% confidence interval, 5.75–16.36). Cumulative incidences of colorectal and biliary cancers increased in patients who were diagnosed with ulcerative colitis at an older age. Conclusions In Korean ulcerative colitis patients, colorectal cancer incidences were not higher than those in the general population regardless of accompanied primary sclerosing cholangitis. However, biliary cancer incidences were much higher in ulcerative colitis patients with primary sclerosing cholangitis than in those without, or in the general population.

BACKGROUND/AIMS: The aims of this study were to evaluate the efficacy and safety of ultrasound-guided percutaneous ethanol ablation for benign cystic thyroid nodules, and to identify the clinical factors associated with therapeutic outcome. METHODS: We examined 46 patients with benign cystic nodules. After removal of cystic fluid, 99% ethanol was injected under ultrasound guidance. Follow-up ultrasonography was then performed 2 weeks and 6-36 months after the therapy to evaluate the early and late response, respectively. An effective response (ER) was defined as volume reduction > 50% or the absence of any residual cystic lesion; partial response (PR) as a 25-50% volume reduction; and no response (NR) as volume reduction < 25% or a volume expansion. RESULTS: During the early response, ER, PR, and NR were 67.4, 30.4, and 2.2%, respectively. The initial mean cyst volume of 12.0 +/- 7.8 mL (3.4-41.3) was reduced significantly after ethanol ablation therapy to 5.4 +/- 3.2 mL (0-33.0; 55% volume reduction, p < 0.001), and to a final late response volume of 4.4 +/- 3.4 mL (0-23.3; 63% volume reduction, p < 0.01). Except for 6 patients who received additional ethanol injection therapies, ER was obtained in 31 of 40 (77.5%) patients in the late response. A large initial volume was the factor associated with therapeutic failure (p = 0.04). Eleven patients (23%) reported transient mild local pain. CONCLUSIONS: Ultrasound-guided ethanol ablation is a safe and highly effective therapeutic method for cystic thyroid nodules. However, more sophisticated approaches are needed for large cystic nodules.
Ethanol* ; Follow-Up Studies ; Humans ; Methods ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography

Kaposi's sarcoma is a neoplasm of multifocal origin which manifests primarily as vascular nodules in the skin and other organs. We report a case of classic Kaposi's sarcoma in a 79-year-old man who had asymptomatic dark-brown macules, papules and nodules on his Rt. lower extremities. The biopsy specimen showed typical histopathologic features of Kaposi's sarcoma including dilated, bizarre-shaped vessels, endothelial cell proliferation, and spindle cell formation with vascular slits throughout the dermis. Many of the spindle-shaped cells associated with the proliferating vessels in Kaposi's sarcoma lesion expressed factor VIII-related antigen. Initially he was treated with 4,000 rads of radiation(200 rad per day for 20 successive days), and after two months 2,500 rads of radiation(500 rad per day for 5 successive days). Three months after radiotherapy, skin lesions were healed leaving hyperpigmentation.
Aged ; Biopsy ; Dermis ; Endothelial Cells ; Humans ; Hyperpigmentation ; Lower Extremity ; Radiotherapy* ; Sarcoma, Kaposi* ; Skin ; von Willebrand Factor

PURPOSE: To determine the metal plate that has almost the same volume and weight as the conventional plate, but has improved properties by changing the shape using finite element analysis. MATERIALS AND METHODS: The bone is assumed to be of 100 mm length, 20 mm outer diameter and 12 mm inner diameter, respectively. There is a fracture line that is perpendicular to the major axis of the bone at the center. The two pieces of bone are joined together using a metallic plate that is made of titanium. Six holes are located, with an interval of 12 mm. We suppose that screws of 2 mm diameter and 25 mm length are inserted in six holes. The metallic plates are of 5 shapes (A, B, C, D and E) in total. Shape A is the standard or nominal type. Shape B and C are thicker at the center of the plate, respectively. Shape D and E are wider at the center. Six types of load are applied to each of those plates: tension, compression, anterior flexion, posterior flexion, lateral flexion and torsion. We compared stress, deformation, maximal stress and maximal deformation, according to the six types of load. RESULTS: Our deliberate investigation using finite element analysis showed that increasing the thickness or width at the center of metallic plates lowered the maximum stress and deformation. In particular, maximal stress and deformation could be reduced by 33.5% and 38.6%, respectively, in the anterior bending situation. Compression showed lower stress and deformation in type C or D, but the absolute quantity was much smaller than others, for example 0.01-0.001 times. CONCLUSION: As for the internal bone fixation plates with the same volume, the wider or thicker in the middle the plate become, the less deformation and yielding it bears.
Axis, Cervical Vertebra ; Bone Plates ; Finite Element Analysis ; Fracture Fixation ; Stress, Mechanical ; Titanium ; Ursidae