PURPOSE: The authors report a case of orbital sarcoidosis without evidence of systemic involvement. CASE SUMMARY: A 33-year-old female had a 1 month history of erythematous eyelid swelling. On physical examination, a firm and non-tender mass was observed diffusely along the upper, lower and medial canthal areas. A computed tomography (CT) scan showed a diffuse mass in the anterior orbit. We performed an incisional biopsy and histopathological examination revealed non-caseating granulomas and no evidence of a foreign body. Acid-fast-bacilli (AFB), methenamine silver and periodic-acid-schiff (PAS) stain showed no evidence of infection and chest radiograph was normal. Polymerase chain reaction (PCR) and interferon gamma secretion test showed no evidence of tuberculosis. Antinuclear antibody (ANA) and antineutrophil cytoplasmic antibody (ANCA) were negative and angiotensin converting enzyme (ACE) was within the normal range. Further systemic evaluations were compatible with a diagnosis of orbital sarcoidosis and oral prednisone was prescribed. Six weeks later, the erythematous eyelid swelling had disappeared and there was no evidence of recurrence to date.
Adult ; Antibodies, Antineutrophil Cytoplasmic ; Antibodies, Antinuclear ; Biopsy ; Diagnosis ; Eyelids ; Female ; Foreign Bodies ; Granuloma ; Humans ; Interferons ; Methenamine ; Orbit* ; Peptidyl-Dipeptidase A ; Physical Examination ; Polymerase Chain Reaction ; Prednisone ; Radiography, Thoracic ; Recurrence ; Reference Values ; Sarcoidosis* ; Tuberculosis

BACKGROUND: Epidural anesthesia is becoming an increasingly important aspect of anaesthetic practice because it has many advantages. To achieve the appropriate sedation, various methods have been described. The authors applied the ketamine for this purpose in subanesthetic dose and compared with the midazolam that has been most commonly used for intravenous sedation. METHODS: Fifty-seven adult patients undergoing lower abdominal and extremity surgery who were receiving epidural anesthesia were randomely enrolled into this clinical study. They were allocated to three groups to receive only normal saline (group C), midazolam 0.05 mg/kg (group M) and ketamine 0.5 mg/kg midazolam 0.05 mg/kg (group K) in normal saline 10ml, respectively. Hemodynamic and respiratory measurements were recorded at baseline, 1 minute, 3 minute, 5 minute, 10 minute, 20 minute and 30 minute after sedation. The degree of sedation was assessed by a blinded observer using sedation score. RESULTS: There were no significant differences for hemodynamic and respiratory parameters, but decrements of arterial pressure at 1 minute after sedation were most remarkable in the group M. Sedation was satisfactorily achieved by combination of ketamine and midazolam without significant emergence reaction. CONCLUSIONS: The combination of ketamine and midazolam was judged to be suitable alternative for sedation during epidural anesthesia.
Adult ; Anesthesia, Epidural* ; Arterial Pressure ; Extremities ; Hemodynamics ; Humans ; Ketamine* ; Midazolam*

To evaluate the effect of adjunctive use of mitomycin C on endoscopic endonasal dacryocystorhinostomy(DCR), a total of 75 eyes of 66 patients diagnosed with naso-lacrimal duct obstruction were assigned randomly to either a mitomycin C group or a control group.The surgical procedures in both groups were exactly the same, except in the patients of mitomycin C group, a topical 0.2 mg/ml solution of mitomycin was applied to the osteotomy site intraoperatively for 5 minutes. Mean follow-up period was 6.8 months in the mitomycin C group and 7.2 months in the control group. The success rate of endoscopic DCR with intraoperative mitomycin C was 89% whereas the success rate of endoscopic DCR without mitomycin C was 79%. Membranous obstruction, causing failure of surgery occurred in five eyes in the control group while it occurred in two eyes in the mitomyicn C group. Synechia with middle turbinate was found in one eye in the control group, but there was no such synechia found in the patients in the mitomycin C group. Granulation tissue formation also occurred in two eyes in the mitomycin C group as well as in two eyes in the control group. During follow-up period, no complications such as mucosal necrosis, or infection were noted in any patients of mitomycin C group. Adjunctive use of mitomycin C as a wound healing inhibitor is considered to increase the success rate of endoscopic endonasal DCR.
Follow-Up Studies ; Granulation Tissue ; Humans ; Mitomycin* ; Necrosis ; Osteotomy ; Turbinates ; Wound Healing

The incidence of the cutaneous tuberculosis has shown a steady decline over the past decades. This parallels the decreasing incidence of pulmonary tuberculosis. We experienced 5 cases of cutaneous tuberculosis from January 1990 to February 1991. We present herein 4 cases of cutaneous tuberculosis. They were 3 cases of vulgaris and 1 case of tuberculosis verrucosa cutis. Mantoux tests were done except one case and were reactive in all cases. Culture for Mycobacterium tuberculosis were done but Mycobacterium tuberculosis were not cultivated in the all cases. Histopathological findings showed tuberculoid granulomas in the dermis except one case and no acid fast bacilli were demonstrated on AFB stains.
Coloring Agents ; Dermis ; Granuloma ; Incidence ; Mycobacterium tuberculosis ; Tuberculosis ; Tuberculosis, Cutaneous* ; Tuberculosis, Pulmonary

After-hours care (AHC) provides medical care after the regular weekday work hours of clinics. In Korea, data from the National Emergency Department Information System showed that approximately 40% of the pediatric patients need AHC. To meet this need, many countries have different models of AHC. In this article, the authors tried to summarize and emphasize the advantages and disadvantages of AHC models in several leading countries. This article can be useful in designing AHC models in Korea because the proportions of potential patients requiring AHC are substantial, and the adoption of AHC models should be seriously considered.
After-Hours Care* ; Ambulatory Care Facilities ; Child ; Delivery of Health Care ; Emergency Service, Hospital ; Humans ; Information Systems ; Korea ; Night Care

Background: This study analyzed the effect of applying the diagnosis-related group (DRG)-based payment system, which was implemented in July 2012 for hospitals and clinics nationwide, on the cesarean section rate. Methods: The subjects of the study were divided into new groups that participated in the payment system after July 2012 and maintenance groups that participated in the payment system before July 2012. As an analysis method, a difference-in-difference analysis, which is a quasi-experimental design, was used. The risk-adjusted cesarean section rate was used as a dependent variable. Results: Seven risk factors (malpresentation of fetus, eclampsia, multiple pregnancies, problems in the placenta, previous Cesarean section, cephalopelvic disproportion, problems in amniotic fluid) were included in the final risk-adjustment model, and found to have a statistically significant relationship with the cesarean section rate. Results showed that the risk-adjusted cesarean section rate increased significantly in new groups after the application of the DRG-based payment system. Conclusion Study results provided policy implications for the reorganization of the DRG-based system should that reflects the demands of obstetricians, such as organizing a consultative body with obstetricians and establishing a reasonable fee.

BACKGROUND: This study aims to analyze the effects of insurance types on the medical service uses for heart failure inpatients using propensity score matching (PSM). METHODS: 2014 National inpatient sample based on health insurance claims data was used in the analysis. PSM was applied to control factors influencing the service uses except insurance types. Negative binomial regression was used after PSM to analyze factors that had influences on the service uses among inpatients. Subjects were divided by health insurance type, national health insurance (NHI) and medical aid (MA). Total charges and length of stay were used to represent the medical service uses. Covariance variables in PSM consist of sociodemographic characteristics (gender, age, Elixhauser comorbidity index) and hospital characteristics (hospital types, number of beds, location, number of doctors per 50 beds). These variables were also used as independent variables in negative binomial regression. RESULTS: After the PSM, length of stay showed statistically significant difference on medical uses between insurance types. Negative binomial regression provided that insurance types, Elixhauser comorbidity index, and number of doctors per 50 beds were significant on the length of stay. CONCLUSION: This study provided that the service uses, especially length of stay, were differed by insurance types. Health policy makers will be required to prepare interventions to narrow the gap of the service uses between NHI and MA.
Comorbidity ; Health Policy ; Heart Failure* ; Heart* ; Humans ; Inpatients* ; Insurance* ; Insurance, Health ; Length of Stay ; National Health Programs ; Propensity Score*

Introduction: Ectropion is an eversion of the eyelid due to various causes, and it mainly develops in the lower lid. Usually it shows a slow progression, and it is classified as involutional, cicatricial, paralytic and congenital. Acute idiopathic bilateral lower lid ectropion is very rare; few cases have been reported worldwide, and none have been seen in Korea. CASE SUMMARY: A 79-year-old male patient visited our department with a six-day history of epiphora and lower lid eversion in both eyes. On slit-lamp examination, lower lid ectropion was present in both eyes, and mild corneal punctate epithelial erosion was also observed. Two weeks after conservative treatment, the lower lid eversion disappeared and the lower lid returned to its original position. No changes were observed three months after treatment. We report a case of acute idiopathic bilateral lower lid ectropion with a literature review.
Aged ; Ectropion ; Eye ; Eyelids ; Humans ; Lacrimal Apparatus Diseases ; Male

Almost all advanced glomerular diseases have glomerular sclerotic changes to varying degrees whatever causes their primary glomerular disease are. Pathogenesis of these sclerosis has been thought of as the hyperfiltration in the primary glomerulosclerosis due to development of glomerular hypertension in each insulted glomeruli. This background gave the theoretical bases for antihypertensive therapies for supporting chronic renal insufficient patients. Angiotensin converting enzyme (ACE) inhibitor, one of the antihypertensive drugs, has received attention recently for its effectiveness. The aims of this study determined the effects and mechanism of the ACE inhibitor, enalapril, on the glomerulosclerosis in FGS/NgaKist mice, which was an animal model of chronic renal failure by generating spontaneously heavy proteinuria and progressive glomerulosclerosis. Five-week-old FGS/NgaKist mice (n=38) were assigned to four groups. Group 1a (n=6) and group 2a (n=8) fed with a vehicle, were sacrificed at the end of 10 weeks and 15 weeks, respectively. Group 1b (n=12) and 2b (n=12) received enalapril (100 mg/L) in drinking water for 5 weeks and 10 weeks from 6th week of age respectively, and were sacrified on the same day as the control groups. Doses of enanapril were maintained to 2 mg/kg/day by measuring the amount of water consumption. In enalapril groups 1b and 2b, systemic blood pressure (74.7 14.0 mm Hg, 74.3 15.9 mmHg) were significantly lower than control group 2a (116.1 4.6 mmHg, P<0.001). Similarly, degree of proteinuria lowered in enalapril group 2b versus control group 2a (0% and 50.0%, P<0.001). Glomerulosclerosis percentage significantly decreased (P<0.001) (group 1b and 2b; 1.9 6.5, 5.6 7.0 vs control 1a and 2a; 32.8 15.5, 31.4 13.8). Glomerulosclerosis score also decreased (P<0.001) (group 1b and 2b; 0.02 0.08 vs control 1a and 2a; 0.48 0.12, 0.30 0.14). The immunofluorescent staining of enalapril groups showed negative for mesangial deposition of IgG, IgA, IgM, and C3 which were positive in control groups. Immunohistochemical staining with TGF-beta1 was negative in enalapril groups and sclerotic glomeruli both enalapril groups and control groups. These results support that the ACE inhibitor has a renoprotective effect on glomerulosclerosis not only by decreasing the blood pressure but also by suppressing the immune deposits on glomeruli.
Angiotensins* ; Animals ; Antihypertensive Agents ; Blood Pressure ; Drinking ; Drinking Water ; Enalapril ; Humans ; Hypertension ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Kidney Failure, Chronic ; Mice ; Models, Animal ; Peptidyl-Dipeptidase A* ; Proteinuria ; Sclerosis* ; Transforming Growth Factor beta1

PURPOSE: This study was done to verify the self-directed learning instrument (SDLI) developed to measure self-directed learning ability in nursing students. METHODS: The participants for the study were 425 nursing college students. Their self-directed learning was verified using self-reports and results through questionnaires. SDLI was translated into Korean through translation/reverse translation process and its content validity verified by five experts. The validity of the instrument was verified through item analysis, exploratory factor analysis, and confirmatory factor analysis. Reliability verification was analyzed using internal consistency reliability. RESULTS: Four factors were identified through exploratory factor analysis and 20 items of the original instrument were found to be valid. In the confirmatory factor analysis, the validity of the instrument was verified as the model was valid. The internal consistency reliability was also acceptable and SDLI was found to be an applicable instrument. CONCLUSION: SDLI has been developed and verified by selecting nursing students as participants for the study. Use if SDLI is expected to improve the quality of self-directed learning in nursing education and to be used in future nursing research.
Education, Nursing ; Humans ; Learning ; Nursing ; Nursing Research ; Reproducibility of Results ; Students, Nursing