Purpose: The purpose of this study was to provide basic data to understand the organizational culture of nurses by categorizing nurses' experience of coping with bullying in the workplace through Q methodology and analyzing the characteristics of each type, and to induce correct policy measures and interventions to create an atmosphere created in the nursing clinical field to be more advanced and positive. Methods: To form the Q population, focus group interviews were conducted with nurses working for more than six months at two general hospitals in Seoul and Gyeonggi. Interviews were conducted by 12 nurses introduced to participants who can provide researchers with a wealth of information on workplace bullying experiences without filtration. In addition, the Q population was extracted by reviewing the results. Based on the results derived from this, 38 Q statements in total were extracted. Forty clinical nurses were required to classify Q sample statements, and the data collected through this were analyzed using the pc-QUANAL program. Results: As a result of the analysis, a total of five types of clinical nurses' experiences of coping with bullying in the workplace were identified: ‘tense emotion-based tolerance response,’ ‘positive thinking-based self-effort response’, ‘individualistic thinking-based passive response’, ‘support system-based emotional expression response’ and ‘active response centered on problem-solving’. Conclusion The derived response types are expected to be guidelines for suggesting strategies to eradicate bullying in the workplace at the organizational level, individual level, prevention level, and organizational culture level.

Squamous cell carcinoma of the pancreas is a rare variant of pancreatic ductal cell carcinoma. Its biologic behavior and clinical features are known to be similar to the much more common ductal adenocarcinoma of pancreas. A 70-year old man with postprandial vomiting symptom was admitted to our hospital. Initial endoscopy and abdominal CT showed that 6cm sized submucosal tumor on pylous or duodenum invaded the pancreas. Subtotal gastrectomy with partial pancreatic resection was done. The resection specimen revealed of metastatic squamous carcinoma of stomach and duodenum. Follow up CT was revealed that multiple liver metastasis and a large mass in peripancreatic space. The mass was confirmed invasive squamous cell carcinoma of pancreas by aspiration biopsy. The patient died of cancer cachexia 50 days after operation. We report an unusual case of squamous cell carcinoma of the pancreas which was invaded to duodenum and pylorus with a review of literature.
Adenocarcinoma ; Aged ; Biopsy, Needle ; Cachexia ; Carcinoma, Squamous Cell* ; Duodenum* ; Endoscopy ; Follow-Up Studies ; Gastrectomy ; Humans ; Liver ; Neoplasm Metastasis ; Pancreas* ; Pancreatic Ducts ; Pylorus* ; Stomach ; Tomography, X-Ray Computed ; Vomiting

We report a patient with an isolated cerebellar nodulus infarction who presented with periodic alternating nystagmus (PAN), perverted head-shaking nystagmus (pHSN), and loss of tilt suppression of the vestibulo-ocular reflex (VOR). Several days after the initial symptoms resolved, the patient also presented with purely vestibular syndrome with vertigo, spontaneous horizontal nystagmus without the usual signs of cerebellar dysfunction. The chain of those symptoms were ascribed to ischemia of the cerebellar nodulus.
Cerebellar Diseases ; Humans ; Infarction* ; Ischemia ; Nystagmus, Pathologic* ; Reflex, Vestibulo-Ocular ; Vertigo

OBJECTIVE: This study evaluated the outcomes of ischemic stroke patients according to delirium motor subtype.METHODS: This study included patients who were admitted to the stroke unit between August 2017 and March 2019 and met the DSM-5 diagnostic criteria for delirium. Patients were assessed twice weekly throughout their delirium episodes using the Korean version of the Delirium Motor Subtype Scale (K-DMSS) and the Korean version of the Delirium Rating Scale-Revised-98 (K-DRS-98). The clinical characteristics and short-term outcomes of the patients were also assessed.RESULTS: A total of 943 stroke patients were included; the rate of incident delirium was 10.18%. Of the 95 delirium patients, 34 were classified as the hyperactive subtype, 30 as the mixed subtype, 25 as the hypoactive and six as no subtype. Among the subtype groups, the hypoactive subtype had the highest initial scores on the National Institutes of Health Stroke Scale (NIHSS; 6.72±4.75, p=0.02) and the modified Rankin Scale (mRS; 3.96±1.24, p<0.01). Additionally, the mixed and hypoactive subtypes had longer durations (p<0.01) and more severe symptoms of delirium (p=0.03) than the other motor subtypes, and the hypoactive subtype group had a significantly longer hospital stay (36.88±27.71 days, p<0.01) than the other subtype groups. After adjusting for baseline covariates in a multiple linear regression analysis, these differences remained significant.CONCLUSION: The present results suggest that the motor subtype of delirium is associated with different characteristics and outcomes in ischemic stroke patients.
Delirium ; Humans ; Length of Stay ; Linear Models ; National Institutes of Health (U.S.) ; Stroke

No abstract available.
Adenoids* ; Carcinoma, Adenoid Cystic*

BACKGROUND: This study was designed to develop a Korean version of the heparin-coated vascular bypass shunt by using a physical dispersing technique. The safety and effectiveness of the thrombo-resistant shunt were tested in experimental animals. MATERIAL AND METHOD: A bypass shunt model was constructed on the descending thoracic aorta of 21 adult mongrel dogs(17.5-25 kg). The animals were divided into groups of no-treatment(CONTROL group; n=3), no-treatment with systemic heparinization(HEPARIN group; n=6), Gott heparin shunt (GOTT group; n=6), or Korean heparin shunt(KIST group; n=6). Parameters observed were complete blood cell counts, coagulation profiles, kidney and liver function(BUN/Cr and AST/ ALT), and surface scanning electron microscope(SSEM) findings. Blood was sampled from the aortic blood distal to the shunt and was compared before the bypass and at 2 hours after the bypass. RESULT: There were no differences between the groups before the bypass. At bypass 2 hours, platelet level increased in the HEPARIN and GOTT groups(p<0.05), but there were no differences between the groups. Changes in other blood cell counts were insignificant between the groups. Activated clotting time, activated partial thromboplastin time, and thrombin time were prolonged in the HEPARIN group(p<0.05) and differences between the groups were significant(p<0.005). Prothrombin time increased in the GOTT group(p<0.05) without having any differences between the groups. Changes in fibrinogen level were insignificant between the groups. Antithrombin III levels were increased in the HEPARIN and KIST groups(p<0.05), and the inter-group differences were also significant(p<0.05). Protein C level decreased in the HEPARIN group(p<0.05) without having any differences between the groups. BUN levels increased in all groups, especially in the HEPARIN and KIST groups(p<0.05), but there were no differences between the groups. Changes of Cr, AST, and ALT levels were insignificant between the groups. SSEM findings revealed severe aggregation of platelets and other cellular elements in the CONTROL group, and the HEPARIN group showed more adherence of the cellular elements than the GOTT or KIST group. CONCLUSION: Above results show that the heparin-coated bypass shunts(either GOTT or KIST) can suppress thrombus formation on the surface without inducing bleeding tendencies, while systemic heparinization(HEPARIN) may not be able to block activation of the coagulation system on the surface in contact with foreign materials but increases the bleeding tendencies. We also conclude that the thrombo-resistant effects of the Korean version of heparin shunt(KIST) are similar to those of the commercialized heparin shunt(GOTT).
Adult ; Animals ; Antithrombin III ; Aorta ; Aorta, Thoracic ; Blood Cell Count ; Blood Platelets ; Fibrinogen ; Hemorrhage ; Heparin ; Humans ; Kidney ; Liver ; Partial Thromboplastin Time ; Protein C ; Prothrombin Time ; Thrombin Time ; Thrombosis

Localized forms of gallbladder adenomyomatosis are rarely polypoid and may mimic gallbladder cancer. Herein, we present a unique case of polypoid gallbladder adenomyomatosis penetrating the colon and preoperatively misdiagnosed as advanced hepatic flexure colon cancer.

A 28-year-old primi gravida visited our department at 20 weeks gestation. The ultrasound screening revealed twin gestation, and follow up screening revealed a bilobed large fetal neck mass in the 1st twin. We measured thyroid volume with ultrasound which was 5.072 cm3. Other fetal organs appeared normal. Cordocentesis was performed for fetal thyroid function and congenital hypothyroidism was confirmed. In addition, maternal thyroid hormones were checked. The other fetus was normal. Thyroid stimulating hormone (TSH) in the maternal serum was increased, but thyroxine (T3) was (within normal range). Two weeks later, we checked TSH and free T4 in amniotic fluid and administered intra-amniotic thyroxine (200 ?g). We repeated the procedures 2 more times in two consecutive weeks. After 3 intra-amniotic thyroxine injection, follow-up cordocentesis revealed euthyroid status of the fetus. Although the thyroid gland had decreased in size and volume, it was still goitrous. At 36 weeks of gestation, the patient was admitted for preterm premature rupture of the membranes and the twin was delivered vaginally. The 1st twin was proved as an euthyroid status and antithyroid antibody was not detected. During the 3 years follow up, the baby had no considerable developmental problem. The intrauterine recognition and treatment of congenital goitrous hypothyroidism may not only reduce the obstetric complications associated with large goiters, but possibly improve the prognosis for normal growth and mental development of affected fetuses.
Adult ; Amniotic Fluid ; Congenital Hypothyroidism ; Cordocentesis ; Female ; Fetal Membranes, Premature Rupture ; Fetus ; Follow-Up Studies ; Goiter ; Humans ; Hypothyroidism ; Mass Screening ; Membranes ; Neck ; Pregnancy ; Prognosis ; Rupture ; Thyroid Gland ; Thyroid Hormones ; Thyrotropin ; Thyroxine ; Twins

BACKGROUND AND PURPOSE: Rapid recanalization might improve clinical outcomes after intraarterial thrombolysis (IAT) for acute ischemic stroke patients with collateral circulation. We determined whether rapid recanalization and collateral circulation affect clinical outcomes after IAT. METHODS: We retrospectively evaluated the clinical and radiological data of 134 consecutive patients who underwent IAT for intracranial artery occlusion. The interval from symptom onset to recanalization after IAT (onset-to-recanalization time) as an estimate of the probability of good clinical outcome (modified Rankin scale 0-2) was calculated in patients with collateral circulation in the ischemic hemisphere, which was rated poor (0/1 American Society of Interventional and Therapeutic Neuroradiology criteria) or good (2-4). Changes in National Institute of Health Stroke Scale (NHISS) score before and after IAT and modified Rankins scale scores 3 months after discharge were compared with respect to onset-to-recanalization time. RESULTS: In patients with good collateral circulation, the estimated onset-to-recanalization time for a 0.5 probability of a good clinical outcome was 347 minutes; with poor collateral circulation, it was 172 minutes for a 0.2 probability of good clinical outcome. Outcome analyses according to onset-to-recanalization time showed patients recanalized <6 hours had lower NHISS scores (<4.5, 4.5-6, >6 hours of onset-to-recanalization time, and non-recanalization: 5.1, 6.9, 11.9, and 19.8, respectively) at discharge and higher percentages of good clinical outcome (69%, 66.7%, 21.9%, and 0%, respectively) 3 months after IAT. CONCLUSIONS: The time window to expect a high probability of a good clinical outcome after IAT is highly dependent on the collateral circulation.
Arteries ; Collateral Circulation* ; Humans ; Retrospective Studies ; Stroke

BACKGROUND AND PURPOSE: We evaluated whether stent-assisted thrombectomy (SAT) is safer or more clinically beneficial than aggressive mechanical clot disruption (AMCD) for patients with acute intracranial artery occlusion. METHODS: We retrospectively analyzed the clinical data of 72 patients (33 with SAT and 39 with AMCD) who underwent intra-arterial thrombolysis for acute intracranial artery occlusions. Procedure parameters, clinical outcomes, and incidence of complications were compared between the SAT and AMCD groups. RESULTS: The time interval to recanalization was shorter in SAT patients (69.2+/-39.6 minutes, mean+/-standard deviation) than in AMCD patients (94.4+/-48.0 minutes, p<0.05). Recanalization was achieved in more SAT patients (91%) than AMCD patients (80%), but with no statistically significance. Urokinase was used less frequently in SAT patients (21%) than in AMCD patients (92%, p<0.05), and the incidence of symptomatic hemorrhages was lower in SAT patients (3%) than in AMCD patients (18%, p<0.05). Device-related complications in SAT patients comprised two cases of stent fracture and one case of distal migration of a captured thrombus. The proportion of patients with good outcomes, defined as scores from 0 to 3 on the modified Rankin Scale, was similar in the two groups at discharge (SAT, 46%; AMCD, 39%), but significantly higher in the SAT group than in the AMCD group at 3 months (64% vs. 40%, p<0.05) and 6 months (67% vs. 42%, p<0.05) after discharge. CONCLUSIONS: The outcomes and clinical parameters were better for SAT during thrombolytic procedures for acute intracranial artery occlusions than for AMCD for up to 6 months. However, some device-related complications occurred during stent interventions.
Arteries ; Cerebral Infarction ; Hemorrhage ; Humans ; Incidence ; Mechanical Thrombolysis ; Retrospective Studies ; Stents ; Stroke ; Thrombectomy ; Thrombosis ; Urokinase-Type Plasminogen Activator