Anal gland/duct cyst (AGC) is rare and observed in only 0.05% of patients undergoing anal surgery. AGC is thought to be a retention cyst in the anal gland and arises when an obstruction of the anal duct causes fluid collection in the anal gland. We report a case of AGC in a 66-year-old woman without anal symptoms. Found by colonoscopy, the AGC was excised transanally. The histopathology of the specimen confirmed AGC. Colonoscopists should include AGC in the differential diagnosis of anal canal mass and rule out of malignancy. Excision is recommended for definitive diagnosis and treatment.

PURPOSE: The purpose of this study was to elucidate nursing performance to superior's ethical leadership as perceived by nurses and the mediating effect of faith in supervisor. METHODS: For this study a descriptive survey design was used. Participants were 258 nurses who worked in general hospital and completed the self-report questionnaire. Data were collected from May 17 to May 31, 2017 and were analyzed using independent t-test, ANOVA, Scheffé test, and Path analysis with SPSS 22.0 and AMOS 21.0. RESULTS: Superior's ethical leadership as perceived by the nurses and faith in the supervisor were significant variables predicting the level of nursing performance and accounted for 48.1% of the variance. Faith in the supervisor as a mediator was found to have a partial mediating effect. CONCLUSION: In order to improve the nurses' performance, it is important to establish a work environment so that hospital nurses can perform their work with faith in their supervisors, as well as having superiors who are ethical leaders.
Hospitals, General ; Leadership* ; Negotiating* ; Nursing* ; Nursing, Supervisory

PURPOSE: We wanted to evaluate the efficacy of transperitoneal laparoscopic renal cyst decortication for treating patients with symptomatic renal cysts. MATERIALS AND METHODS: From January 2000 to July 2006, 57 patients with symptomatic renal cysts underwent transperitoneal laparoscopic renal cyst decortication. The mean age of the patients was 56.0 years old (29-77) and the male to female ratio was 1:1.2. The mean size of the renal cysts was 6.6cm (range: 4-11). The laterality of the renal cyst was on the left side in 31 cases, the right side in 11 and it was bilateral in 15. The location of the cysts was at the upper pole in 23 cases, at the middle pole in 13 cases and at the lower pole in 21 cases. All the procedures were performed via the transperitoneal approach. The preoperative and postoperative data were collected retrospectively. The mean follow-up period was 44.1 months (range: 3.2-66.2). RESULTS: The mean operation time was 68.3 minutes (range: 35-280) and the mean blood loss was 42.1cc (range: 30-150). With the mean follow-up of 44.1 months, 52 patients were asymptomatic and 5 patients were still symptomatic. For follow-up, abdominal ultrasonography was performed for 53 of 57 cases and computed tomography (CT) was performed in the others. The success rate was 94.7% (54/57) and the complication rate was 7.0% (4/57). CONCLUSIONS: Laparoscopic renal cyst decortication in patients with symptomatic renal cysts via the transperitoneal approach seems to be an effective procedure to achieve symptomatic relief with minimal morbidity and an acceptable long-term success rate.
Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Retrospective Studies ; Ultrasonography

OBJECTIVE: The purpose of this study was to understand the differences in masseter muscle (MM) between the shifted and non-shifted sides in facial asymmetry patients, and the changes shown by MM after mandibular surgery. METHODS: Pre- and post-operative CT scans were performed on 12 Class III patients with facial asymmetry who were treated by intraoral vertical ramus osteotomy and 10 subjects with normal occlusion. Using the V-works 4.0 program (Cybermed, Seoul, Korea), 3-dimensional images of the mandible, and MM were reconstructed, and evaluated. RESULTS: In the asymmetry group, the MM angle between the shifted and non-shifted sides was only significantly different (p < 0.05). Compared with normal occlusion, the asymmetry group showed a significantly smaller volume and maximum cross-sectional area in both sides of MM (p < 0.05). After mandibular surgery, the angle of MM (p < 0.01) and differences in angle between the shifted and non-shifted sides of MM (p < 0.05) were significantly decreased. The thickness in the maximum cross-sectional area was significantly increased (p < 0.01). After surgery, MM in facial asymmetry patients was similarly changed to those in the normal occlusion group except for widths. CONCLUSIONS: MM in facial asymmetry was definitely different from those in normal occlusion. However, this study suggests that MM changed symmetrically in conjunction with the mandible after proper mandibular surgery.
Facial Asymmetry ; Humans ; Mandible ; Masseter Muscle ; Orthognathic Surgery ; Osteotomy

Hidradenoma papilliferum is a rare benign cystic tumor that originates from apocrine glands or anogenital mammary glands. Here, we describe 2 cases of hidradenoma papilliferum of the anus. Two female patients aged 39 and 35 presented with perianal masses with hemorrhoids. The patients underwent hemorrhoidectomy and excision of the lesion. Histopathology confirmed the masses as hidradenoma papilliferum. The postoperative course was uneventful for both patients, and there were no recurrences after 18 and 12 months of follow-up, respectively. Proctologists should consider hidradenoma papilliferum in their differential diagnosis of benign anal tumors. Surgical excision is necessary for diagnosis and treatment of hidradenoma papilliferum.
Acrospiroma ; Anal Canal ; Apocrine Glands ; Diagnosis ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Mammary Glands, Human ; Recurrence

BACKGROUND: The IgH gene rearrangement (IgH GR) involving highly specific CDR3 region can be used as a minimal residual disease marker in ALL. The IgH GR-PCR has the advantages of the high positive rate in ALL and the detection of clonal evolution. METHODS: In 30 cases of childhood ALL, the DNA was extracted from the bone marrow aspirates at the diagnosis and during the chemotherapy. The 40 cycle polymerase chain reaction was performed with seven each VH family specific primer and common JH primer. The PCR products were electrophoresed on the agarose gel, and those showing specific bands were electrophoresed on 6M urea 6% polyacrylamide DNA sequencing gel. We compared and analyzed the IgH GR-PCR results, the morphologic diagnosis of the bone marrow and the clinical course. RESULTS: IgH GR was detected in 93.3% (28/30) at the diagnosis and the rest of two cases showed IgH GR during the therapy. IgH GR was detected in all specimens diagnosed as persistence, partial remission and relapse, the 80.0% of hypocellular marrow with persistence of blasts, the 72.7% of hypocellular marrow, and the 59.2% of complete remission. In the complete remission states the patients with IgH GR showed significantly higher relapse rate (26.2%) than those without IgH GR (7.1%) (p=0.019). Number of clones of IgH GR was from one to five. The more number of clones showed the shorter mean survival time (p=0.1172). The usage of VH3 was most frequent (70.0%). IgH GR had been detected average 3.5 months (range 1-12 months) earlier than the morphologic relapse appeared. During the chemotherapy the evolution of IgH GR was observed in the seven cases (23.3%). CONCLUSIONS: The IgH GR-PCR will help the understanding of biological characteristics of leukemic cells, the interpretation of the bone marrow studies after chemotherapy and the plans of further therapy, and can be used as a prognostic indicator in the morphologic complete remission state.
Bone Marrow ; Clonal Evolution ; Clone Cells ; Diagnosis ; DNA ; Drug Therapy ; Gene Rearrangement ; Humans ; Neoplasm, Residual* ; Polymerase Chain Reaction ; Population Characteristics ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Recurrence ; Sepharose ; Sequence Analysis, DNA ; Survival Rate ; Urea

BACKGROUND: The Wilms' tumor gene (WT1) is located on chromosome 11p13. Several authors have shown that the expression of WT1 gene is associated with prognosis of acute leukemia. It was the aim of this study to investigate the relationship between WT1 positivity and the response to treatment in terms of rate of complete remissions (CR), and survival and to evaluate the prognostic value of WT1 expression in patients with acute leukemia. METHODS: We examined the presence of WT1 specific mRNA in bone marrow samples of 71 patients with acute leukemia at diagnosis (AML 39, ALL 32) by nested RT-PCR. The integrity and the amount of RNA were analyzed by amplification of the -actin gene as an internal control. The relative ratio of WT1 gene expression/ -actin was calculated and classified as not amplified (0), weakly amplified (1+), moderately amplified (2+), or strongly amplified (3+). RESULTS: Thirty-four (47.9%) of the patients with acute leukemia at diagnosis were WT1 PCR positive. Among the WT1 positive patients, 10 patients (14.1%) showed 1+, 20 patients (28.2%) 2+, and 4 patients (5.6%) 3+. The patients with WT1 mRNA expression were younger than those without it in AML. There was a tendency of a higher CR rates in WT1 negative patients than in WT1 positive ones (AML 61.9% vs. 50%, ALL 75.0% vs. 68.8%). The probability of 5 year survival was 62.2% for WT1 negative group and 44.1% for WT1 positive group in all patients. The median survival days accord-ing to levels of WT1 expression was 709 days for negative group, 310 days for 1+ or 2+ groups and 294 days for 3+ group. CONCLUSIONS: The present data suggest a clinical relevance of WT1 expression for the achieve-ment of CR and long term survival in acute leukemia. Analysis of WT1 expression with bone mar-row aspirates at the diagnosis of acute leukemia may be useful to predict prognosis.
Bone Marrow ; Diagnosis ; Gene Expression* ; Humans ; Leukemia* ; Polymerase Chain Reaction ; Prognosis ; RNA ; RNA, Messenger ; Wilms Tumor

BACKGROUND AND OBJECTIVES: Hypercholesterolemia is a key factor in the development of atherosclerosis. We sought to evaluate the relation between hypercholesterolemia and plaque composition in patients with coronary artery disease. SUBJECTS AND METHODS: Study subjects consisted of 323 patients (mean 61.5 years, 226 males) who underwent coronary angiography and virtual histology-intravascular ultrasound examination. Patients were divided into two groups according to total cholesterol level: hypercholesterolemic group (> or =200 mg/dL, n=114) and normocholesterolemic group (<200 mg/dL, n=209). RESULTS: Hypercholesterolemic patients were younger (59.7+/-13.3 years vs. 62.6+/-11.5 years, p=0.036), than normocholesterolemic patients, whereas there were no significant differences in other demographics. Hypercholesterolemic patients had higher corrected necrotic core volume (1.23+/-0.85 mm3/mm vs. 1.02+/-0.80 mm3/mm, p=0.029) as well as percent necrotic core volume (20.5+/-8.5% vs. 18.0+/-9.2%, p=0.016) than normocholesterolemic patients. At the minimal lumen area site, percent necrotic core area (21.4+/-10.5% vs. 18.4+/-11.3%, p=0.019) and necrotic core area (1.63+/-1.09 mm2 vs. 1.40+/-1.20 mm2, p=0.088) were also higher than normocholesterolemic patients. Multivariate linear regression analysis showed that total cholesterol level was an independent factor of percent necrotic core volume in the culprit lesion after being adjusted with age, high density lipoprotein-cholesterol , hypertension, diabetes mellitus, smoking and acute coronary syndrome (beta 0.027, 95% confidence interval 0.02-0.053, p=0.037). CONCLUSION: Hypercholesterolemia was associated with increased necrotic core volume in coronary artery plaque. This study suggests that hypercholesterolemia plays a role in making plaque more complex, which is characterized by a large necrotic core, in coronary artery disease.
Acute Coronary Syndrome ; Atherosclerosis ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Demography ; Diabetes Mellitus ; Humans ; Hypercholesterolemia ; Hypertension ; Linear Models ; Smoking

Depression is a common mental illness with a high lifetime prevalence rate in the general population. However, the pathophysiology of depression is still poorly understood. Recent studies showed that environmental factors can affect gene expression by modifying epigenetic factors. Early life stress (ELS) is likely a risk factor of lifetime vulnerability to stress and development of depression. ELS or stressful lifetime can induce changes in gene expression through epigenetic mechanism, such as DNA methylation or histone modification. In this article, recent researches on the epigenetic mechanisms of depression will be discussed.
Depression* ; DNA Methylation ; Epigenomics* ; Gene Expression ; Histones ; Prevalence ; Risk Factors ; Stress, Psychological

OBJECTIVE: Distal anterior cerebral artery (DACA) aneurysms are relatively uncommon and surgical management presents some unique technical difficulties. We retrospectively reviewed our experience with 35 DACA aneurysm cases, their clinical features and treatment outcomes to assess the characteristics and treatment outcomes of DACA aneurysms. MATERIALS AND METHODS: The medical records of 33 patients with 35 ruptured and unruptured DACA aneurysms were reviewed. Of these, 29 had undergone surgery and four were treated by coil embolization at our institution between September 1992 and January 2010. The clinical presentation, radiologic features and surgical and endovascular treatment outcomes were analyzed. RESULTS: In our series, the incidence of DACA aneurysms was 35 of 1106 (3.1%) aneurysms. The most common location of these 35 aneurysms was the bifurcation of the pericallosal and callosomarginal arteries (51%). Multiple aneurysms were found in nine patients (27%) and associated vascular anomalies such as azygous anterior cerebral artery and Moyamoya disease were found in six patients (18%). Ninety four percent of the aneurysms were less than 10 mm in diameter. Twenty nine patients were treated by surgical clipping and four patients were treated by coil embolization. Premature rupture of aneurysms and mortality or morbidity directly related to the aneurysmal surgery or endovascular treatments were not observed. CONCLUSION: DACA aneurysms have a tendency to rupture before becoming large or giant in size. We achieved favorable outcomes (modified Rankin Scale <4) in 29 of the 33 patients with a tailored surgical approach and coil embolization. Therefore, DACA aneurysms should be treated aggressively even if they are <10 mm in diameter and early surgery can reduce the rate of rebleeding.
Aneurysm ; Anterior Cerebral Artery ; Arteries ; Humans ; Incidence ; Intracranial Aneurysm ; Medical Records ; Moyamoya Disease ; Retrospective Studies ; Rupture ; Surgical Instruments