Objective: The purpose of the present study was to screen the prevalence of aneurysms in migraineurs; to differentiate presenting features in migraineurs with and without aneurysm; and also to correlate the locations of aneurysm to the clinical features of migraine. Methods: A total of 4,416 subjects were interviewed and completed self-reported questionnaires on headache. Of these, 1,773 subjects diagnosed to have migraines based on the International Classification of Headache Disorders II (ICHD-II) criteria were screened for aneurysm by magnetic resonance angiography (MRA). When aneurysm was suspected, further investigation with trans femoral cerebral angiography (TFCA) or three dimensional computerized tomography (CT) angiography was performed. Based upon MRA findings, subjects were grouped into unruptured aneurysm migraine patients (UAMP) and no aneurysm migraine patients (NAMP). Results: The prevalence of aneurysm was 3.6% (63 of 1,773) with the mean age of 56.0 years, which were not different from those of general population. There was no difference in migraine subtypes between UAMP and NAMP. Aggravation of headache by estrogen replacement therapy during menopause (p=.039), history of migraine in young age (p= .021), diplopia (p=.026), and retroauricular pain (p=.025) were significantly associated with presence of aneurysm. Although aneurysms were detected more in anterior circulation, there was no correlation between aneurysm site and headache location. The average size of aneurysm was 3.5 ± 2.1 mm and none were ruptured. Interventional therapy of aneurysm did not alter the feature of migraine. Conclusions: The incidence of aneurysm was not different in migraine patients as compared to the general population. Some features which significantly differentiate whether migrainuers have aneurysm or not warrant further study to have a predictive and localizing value.

Cancer metastasis to the skin, especially epidermotropic metastasis, is uncommon. Sometimes it is difficult to find the primary lesion; immunohistochemical (IHC) staining of cutaneous metastasis is used to determine the origin, but diagnosis may occasionally prove difficult. A 77-year-old man visited our hospital with a 1-month diagnostic history of multiple nodules in the right axilla. The patient had undergone surgery for gastric adenocarcinoma (T3N3M0) 21 years ago, and was diagnosed with lung adenocarcinoma 1 year previously; however, no treatment was ongoing. Biopsy of the lesions revealed atypical cells surrounding the papillary projections of the epidermis and tumor nests of the upper dermis. IHC staining was positive for CK7 and CEA and negative for CK5/6, CK20, napsin A, TTF-1, GCDFP 15, and p63. The tissues revealed glandular structures and tested negative for p63 and CK5/6 on IHC staining. The patient was diagnosed with epidermotropic metastasis of lung adenocarcinoma.

omega6 and omega3 fatty acids are important cellular components and known to be involved in disease processes. However, few studies have focused on mucosa fatty acid in human gastric cancer. The purpose of this study was to investigate how fatty acid patterns of mucosa are altered in gastric cancer. Fatty acids were analyzed by gas chromatography and their relative compositions (%) were determined and evaluated both in mucosa total-fatty acids and in phospholipid-fatty acids in paired cancerous and non-cancerous gastric cancer tissues (n = 18). The level of arachidonic acid (20:4omega6, AA) appeared significantly higher both in phospholipid-fatty acids (p < 0.05) and in total-fatty acids (p < 0.001) in cancerous mucosa compared to non-cancerous mucosa. The omega6/omega3 fatty acid ratio of phospholipid-fatty acids was also significantly higher in cancerous mucosa. The higher level of AA in cancerous tissue can be partially explained by the higher ratio of 20:4omega 6/20:3omega6 (desaturation index) and the lower ratio of 22:4omega6/20:4 omega6 (elongation index). The change in the relative composition of arachidonic acid may influence the production of prostaglandins and related metabolites, which regulate cell differentiation and proliferation. The findings of this study with respect to fatty acid changes, especially in terms of arachidonic acid metabolism, may be of relevance in the understanding of the roles of specific fatty acids and possibly of eicosanoids in gastric cancer.
Adult ; Aged ; Arachidonic Acid/metabolism ; Fatty Acids/metabolism* ; Female ; Gastric Mucosa/metabolism* ; Human ; Male ; Middle Age ; Phospholipids/metabolism ; Stomach Neoplasms/metabolism*

Tamoxifen and radiotherapy are used in breast cancer treatment worldwide. Radiation recall dermatitis (RRD), induced by tamoxifen, has been rarely reported. Herein, we report a RRD case induced by tamoxifen. A 47-year-old woman had a right quadrantectomy and an axillary lymph node dissection due to breast cancer. The tumor was staged pT2N0; it was hormone receptor positive, and human epidermal growth factor receptor 2 negative. The patient received adjuvant chemotherapy followed by tamoxifen and radiotherapy. After 22 months of tamoxifen, the patient developed a localized heating sensation, tenderness, edema, and redness at the irradiated area of the right breast. The symptoms improved within 1 week without treatment. Three weeks later, however, the patient developed similar symptoms in the same area of the breast. She continued tamoxifen before and during dermatitis, and symptoms resolved within 1 week.
Breast ; Breast Neoplasms* ; Chemotherapy, Adjuvant ; Dermatitis ; Edema ; Female ; Heating ; Hot Temperature ; Humans ; Lymph Node Excision ; Middle Aged ; Radiodermatitis* ; Radiotherapy ; Receptor, Epidermal Growth Factor ; Sensation ; Tamoxifen*

PURPOSE: The purpose of this study was to investigate the effects of simulation in nursing education based on caring for elderly cognition disorder patients. The education consisted of a caring program for patients that included a process of assessment of a patient's mental status, diagnosis of the patient's health condition, and intervention to address the problems by using therapeutic communication. METHODS: A nonequivalent control group pretest-posttest design was used. A total of 69 subjects (undergraduate students) participated in the education and they were assigned to two groups: the experimental group (n=32) and the control group (n=37). Data-gathering structured questionnaires that included communication competence, academic self-efficacy, and attitudes about the elderly. The data were collected from October 2013 to December 2013, and statistical analyses were conducted with-test and t-test using the SPSS 21.0 program. RESULTS: With respect to education, there was significant improvement in communication competence in the experiment group (t=2.41, p=.022) compared with in the control group (t=.69, p=.494). However, there was no statistically significant difference in academic self-efficacy and attitude about the elderly. CONCLUSION: Simulation-based education should continue to be developed further for better elderly-patient care. Integrated education in particular using a high-fidelity simulator will contribute to improvements in nursing competence in this area.
Aged* ; Cognition ; Cognition Disorders ; Diagnosis ; Education* ; Education, Nursing ; Humans ; Learning* ; Mental Competency* ; Nursing ; Patient Simulation ; Surveys and Questionnaires ; Students, Nursing*

PURPOSE: The purpose of this study was to analyze the cardiopulmonary resuscitation skills and teamwork of nurses in simulated cardiac arrests in the hospital. METHODS: A descriptive study was conducted with 35 teams of 3 to 4 registered nurses each in a university hospital located in Seoul. A mannequin simulator was used to enact simulated cardiac arrest. Assessment included critical actions, time elapsed to initiation of critical actions, quality of cardiac compression, and teamwork which comprised leadership behavior and communication among team members. RESULTS: Among the 35 teams, 54% recognized apnea, 43% determined pulselessness. Eighty percent of the teams compressed at an average elapsed time of 108+/-75 seconds with 35%, 36%, and 67% mean rates of correct compression depth, rate, and placement, respectively. Thirty-seven percent of the teams defibrillated at 224+/-67 seconds. Leadership behavior and communication among team members were absent in 63% and 69% of the teams, respectively. CONCLUSION: The skills of the nurses in this study cannot be considered adequate in terms of appropriate and timely actions required for resuscitation. Future resuscitation education should focus on improving the quality of cardiopulmonary resuscitation including team performance targeting the first responders of cardiac arrest.
Adult ; Attitude of Health Personnel ; *Cardiopulmonary Resuscitation ; Clinical Competence ; Communication ; Defibrillators ; Female ; Heart Arrest/*therapy ; Hospitals, University ; Humans ; Leadership ; Male ; Nursing Staff, Hospital ; Patient Care Team ; *Patient Simulation ; Quality of Health Care ; Time Factors

A 48-year-old woman presented with a 1-day history of aggressive behavior. Hashimoto encephalopathy was first suspected based on elevated levels of serum anti-thyroid peroxidase antibody. Her clinical symptoms did not improve despite treatment with intravenous corticosteroid. Abdominal computed tomography revealed liver cirrhosis, and brain T2-weighted magnetic resonance imaging revealed midbrain hyperintensity, and she was finally diagnosed with Wilson’s disease. The Wilson’s disease should be considered in the differential diagnosis in adults presenting with unexplained hepatic, neurological, or psychiatric abnormalities.

To improve trauma outcomes, a solid logistic support system is obviously crucial. An important national trauma outcome indicator is preventable trauma death rate, 35% in Korea. The Korean government is aware of this figure and is making efforts to reduce the preventable trauma death rate by 20%. One of the main components was establishing regional trauma centers covering the Korean peninsula, and a trauma care system. Seventeen regional trauma centers will be verified by the year of 2020. To achieve this goal, trauma specialist medical staff's role is essential. A trauma system is very complicated. It involves a broad range of health care fields from the prehospital setting to rehabilitation. In addition, a number of professionals, institutions and authorities are involved. Thus, very sophisticated systemic approaches are needed. An essential initial component is surveillance, which can start with collecting data and analyzing them thoroughly with a suitable trauma scoring system to describe the characteristics of injured patients in Korea. Several trauma scoring systems are available in Korea. However, these systems need validation to decide which is pertinent for a records- based Korean trauma system. Although the Korean Trauma Data Bank (KTDB) is recently established, it can be used for a predictive model in Korea.
Delivery of Health Care ; Humans ; Injury Severity Score ; Korea* ; Mortality ; Outcome Assessment (Health Care)* ; Rehabilitation ; Specialization ; Trauma Centers