PURPOSE: The purpose of this study was to analyze and clarify the concept of gratitude. METHODS: A review of the literature was conducted using several databases. The databases were searched using the following keywords: gratitude, positive psychology, concept analysis. Literatures related to gratitude was reviewed using the framework of Walker and Avant's conceptual analysis process. RESULTS: Gratitude can be defined by the following attributes: 1) expression of interaction, 2) power of drawing positive change, and 3) growth of phases by training and habit. The antecedents of gratitude are as follows: 1) soothing one's anger, 2) decreasing complaints, and 3) increasing expressions of gratitude. The consequences of gratitude are as follows: 1) positive change in oneself, 2) positive change in others, and 3) positive change in the environment. CONCLUSION: The theoretical definition for gratitude will provide a common understanding of this concept and differentiate it from other types of gratitude in the nursing. This clarification and conceptualization of the concept will assist further research of the concept and advance the boundaries of practical applications in nursing for various people.
Anger ; Nursing ; Psychology

As is well known, myxoma of the heart is very rare(incidence 0.03%), constituting nearly 50% of all primary cardiac tumors. It is important because it can be abolished by surgical removal but usually fatal if unrecognized or untreated. Recently a wider use of echocardiogram as the screening test of valve lesions can be expected to increase the number of myxomas found preoperatively. We have experienced a case of bilateral atrial myxoma which simulated mitral valvular disease clinically and had typical three cardinal manifestations such as obstructive, embolic and constitutional symptoms. The patients was 39 years old woman. The left atrial myxoma was diagnosed preoperatively by echocardiography and cardiac angiography and the remainder during open heart surgery under the E.C.C. Both of them were removed successfuly and confirmed as typical myxoma microscopically. This is the first case report of bilateral atrial myxoma in Korea to our knowledge.
Adult ; Angiography ; Echocardiography ; Female ; Heart ; Heart Neoplasms ; Humans ; Korea ; Mass Screening ; Myxoma* ; Thoracic Surgery

PURPOSE: Acute appendicitis still remains one of the most common causes of childhood abdominal surgery. Despite of the development of modern diagnostic tools, it presents more serious problems than in adults due to the higher perforation rate. METHODS: In our hospital, 5-year term clinical reviews have been performed, over the last 2 decades to see if there were any changing tendencies of this disease entity. We reviewed 186 cases of child acute appendicitis between January 1997 and December 2001. RESULTS: The results were as follows: 1) The male to female ratio was 1.35: 1. 2) The peak incidence occurred in the 11 to 15 years old age group. 3) The overall perforation rate was 24.7%, which was decreased compared with 34.7% of our previous study (P<0.05, Odd ratio=0.60). 4) The negative exploration rate was 8.06%. 5) The overall complication rate were 2.85% and 32.6% in non-perforated and perforated cases, respectively. CONCLUSION: In conclusion, the incidence of acute appendicitis were shown to be almost the same as for the previous decade, but the perforation rate had dropped, maybe due to the early intervention, and advances in the diagnostic tools.
Adult ; Appendicitis* ; Child* ; Early Intervention (Education) ; Female ; Humans ; Incidence ; Male

Heterotopic pregnancy, simultaneous intrauterine and extrauterine gestations, is a relatively rare conditon with an estimated incidence of 1 in 30,000 pregnancies in a natural cycle. But the incidence of heterotopic pregnancies has been increased because of rising incidence of pelvic inflammatory disease, pelvic surgery, intrauterine device, the use of various ovulation induction and assisted reproductive technologies, such as in vitro fertilization and embryo transfer, gamate intrafallopian insemination. The early diagnosis of heterotopic pregnancy is very difficult. So there is a higher maternal morbidity, mortality and fetal loss. Thus careful pelvic examination, combined with serial beta hCG determinations and transvaginal sonography to evaluate the adnexal region are important. We experienced a case of 34-years-old multiparous women with heterotopic pregnancy in natual cycle confirmed by surgical removal of ruptured right tubal pregnancy and sonographic finding of the intrauterine pregnancy, which carried the intrauterine pregnancy to term delivery without complication at 39+5 weeks of gestation, and report this case with a brief review of the literature.
Early Diagnosis ; Embryo Transfer ; Female ; Fertilization in Vitro ; Fertilization* ; Gynecological Examination ; Humans ; Incidence ; Insemination ; Intrauterine Devices ; Mortality ; Ovulation Induction ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Pregnancy, Tubal ; Reproductive Techniques, Assisted ; Ultrasonography

OBJECTIVES: Metabolic and endocrinologic alterations is developed at menopausal transition of women and these alterations can have an effect on prevalence of metabolic syndrome. Therefore, we evaluated the prevalence of metabolic syndrome and differences of components as menopausal status of women who visited our health screening clinic. METHODS: We surveyed body sizes, blood pressures and other several blood tests from January 2006 to December 2010 in Pusan National University Hospital by retrospectively reviewing medical records. These results were compared as presence of metabolic syndrome and menopausal status. Differences of the components of metabolic syndrome as the menopausal status and occurrences of metabolic syndrome as the age and the menopausal status are investigated. RESULTS: In premenopausal and postmenopausal women, the prevalence of metabolic syndrome were 8.69% and 21.85%, respectively. More body weight, high body mass index and cholesterol were checked in women who have metabolic syndrome irrespective of menopausal status. Low high density lipoprotein was most prominent component of metabolic syndrome irrespective of menopausal status. Hypertension and high blood sugar were showed meaningful proportions in postmenopausal women. The prevalence of metabolic syndrome was unrelated to the menopausal status by regressively analyze, but meaningfully increased related to aging. CONCLUSION: Menopausal alterations restrictively effect on occurrence of metabolic syndrome and aging is more effect on it. But more detailed and additional studies are needed about determining the relation of metabolic syndrome in women who surgically menopaused and receiving hormone therapy.
Aging ; Blood Glucose ; Body Mass Index ; Body Size ; Body Weight ; Cholesterol ; Female ; Hematologic Tests ; Humans ; Hypertension ; Lipoproteins ; Mass Screening ; Medical Records ; Menopause ; Prevalence ; Retrospective Studies

Since 1976, 938 cases of E.R.C.P. were performed at the Kwangju Christian Hospital & since December 1981, 19 cases of Endoscopic papillotomy(E.P.T.) were performed, following Results were obtained: 1) Out of 19 cases which were diagnosed by E.R.C.P.; 17 cases of C.B.D. stones, 1 case of ascaris in bile duct, 1 case of remained C.B.D. stone diagnosed by T-tube cholangiogram after operation, & E.P.T. was done in total 19 casees. 2) During 1st E.P.T., 2 cases were removed by Dormia basket under direct visualization & during 2nd E.P.T., 5 cases were removed by Dormia basket under direct visulization & 12 cases were passed in stool & 3x3.5cm large stone passage was found. 3) Complications of E.P.T. were noted in 2 cases: 1 case of bleeding was treated by blood transfusion & 1 case of Acute pancreatitis was treated by medical care.
Ascaris ; Bile Ducts ; Blood Transfusion ; Common Bile Duct* ; Gwangju ; Hemorrhage ; Pancreatitis ; Sphincterotomy, Endoscopic*

OBJECTIVES: This study was performed to assess the risk factors, histologic and clinical features of breast cancer in postmenopausal women receiving hormone therapy (HT). METHODS: We evaluated 40 breast cancer patients who received HT due to postmenopausal symptoms by reviewing their medical charts at Pusan National University Hospital. Research variables, including patients' history, type and duration of received HT, moment of cancer debut after starting HT, radiological characteristics of breast cancer stage, histologic type, tumor size, grade, lymph node metastasis, estrogen and progesterone receptor status and 5-year survival were investigated. RESULTS: In the risk factors of breast cancer patients, only one patient had familial history of breast cancer. No patient had smoking history. The average body mass index (BMI) was 23.2 kg/m2. Twelve patients (30%) had estrogen only therapy, 13 patients (32.5%) had combined estrogen and progesterone therapy, 10 patients (25%) had tibolone therapy and the others consecutively received combination therapy of the above regimens. The mean duration of treatment was 31 +/- 27.9 months (range 0.4-115 months). In the distribution of the cancer debut after starting HT, in 4 cases (10%) was within 1 year, 5 cases (12.5%) within 1-2 years, 10 cases (25%) within 2-3 years, 4 cases (10%) within 3-4 years, 1 case (2.5%) within 4-5 years, and 16 cases (40%) within more than 5 years. The average diameter of tumor size was 1.7 cm. In 92.5% of cases, the tumor was of ductal type. Tumor stage 0 and 1 appeared in 66% and grade I was present in 38% of investigated cases. Hormone receptor-positive breast cancers were 85% and 70% of patients had negative lymph node metastases. The 5-year survival rate was 92%. CONCLUSION: The breast cancers which emerged during HT in postmenopausal women had hormone receptor-positive tendency. The size and stage of these breast cancers were shown as small and low, and represented low-grade differentiation. Recurrences of disease were uncommon and we found favorable 5-year survival rates and good prognosis.
Body Mass Index ; Breast ; Breast Neoplasms ; Estrogens ; Female ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Norpregnenes ; Progesterone ; Prognosis ; Receptors, Progesterone ; Recurrence ; Risk Factors ; Smoke ; Smoking ; Survival Rate

Mammals have two major isoforms of acetyl-CoA carboxyase (ACC). The 275 kDa beta-form (ACC beta) is predominantly in heart and skeletal muscle while the 265 kDa alpha-form (ACC alpha) is the major isoform in lipogenic tissues such as liver and adipose tissue. ACC alpha is thought to control fatty acid oxidation by means of the ability of malonyl-CoA to inhibit carnitine palmitoyl-CoA transferase-1 (CPT-1), which is a rate-limiting enzyme of fatty acid oxidation in mitochondria. Previously, it was reported that MyoD and other muscle regulating factors (MRFs) up-regulate the expression of ACC beta by interactions between these factors and several cis-elements of ACC beta promoter. We described here that ACC beta expression mediated by MRFs is regulated by retinoic acids. Endogenous expression of ACCb in differentiated H9C2 myotube was significantly increased by retinoic acid treatment. However, on transient transfection assay in H9C2 myoblast, ACC beta promoter activity was suppressed by RXRa and more severely by RAR alpha. These effects on ACCb expression in myoblasts and myotubes by RXR alpha and RAR alpha seem to be mediated by their interactions with MRFs because no consensus sequence for RXR alpha and RAR alpha has been found in ACC beta promoter and retinoic acid receptors did not affect this promoter activities by itself. In transient transfection in NIH3T3 fibroblast, the activation of ACC beta promoter by MyoD, main MRF in myoblast, was significantly suppressed by RAR alpha and to a less extent by RXR alpha while the RXR alpha drastically augmented the activation by MRF4, major MRF in myotube. These results explained that retinoic acids differentially affected the action of MRFs according to their types and RXR alpha specially elevates the expression of muscle specific genes by stimulating the action of MRF4.
3T3 Cells ; Acetyl-CoA Carboxylase/genetics/*metabolism ; Animals ; Cell Differentiation ; Cells, Cultured ; Gene Expression Regulation, Enzymologic/drug effects ; Mice ; MyoD Protein/*metabolism ; Myoblasts/drug effects/metabolism ; Myogenic Regulatory Factors/*metabolism ; Promoter Regions (Genetics)/drug effects ; Receptors, Retinoic Acid/genetics/*metabolism ; Trans-Activation (Genetics) ; Transcription Factors/genetics/*metabolism ; Tretinoin/pharmacology

Acquired periungual fibrokeratomas are rare, benign, fibrous and hyperkeratotic tumours. They usually present as lesions which emerge from the proximal nail fold, or sometimes from the nail bed. Although acquired periungual fibrokeratoma is considered as a topographical variant of acquired digital fibrokeratoma, it has a unique "garlic-clove" shape and causes nail deformity. We present herein a case of acquired periungual fibrokeratoma occurring beneath the proximal nail fold. Histologically, an accessory germinal matrix was observed at the distal end of the lesion. Change in pressure around the lesion seemed to have induced the formation of this accessory germinal matrix.
Congenital Abnormalities

In Korea, Plasmodium vivax (P. vivax) is the most common agent of malaria infection. However, as travel to regions where malaria is endemic increases, so do the numbers of Plasmodium falciparum and mixed infections. P. falciparum predominates, while P. vivax is rare in west-central Africa. We report on a case of mixed malaria infection with severe hemolytic anemia caused by P. falciparum and P. vivax in a 38-year-old man after traveling to Angola. A diagnosis of P. falciparum malaria was made by microscopic examination. However, both P. vivax and P. falciparum were detected by the polymerase chain reaction (PCR). As a radical cure P. vivax, the patient was treated with mefloquine, artemether, and primaquine. Both P. falciparum and P. vivax had disappeared from peripheral blood by admission day 4, however, low grade fever and headache persisted, and his hemoglobin and hematocrit levels were depleted. A peripheral blood smear was negative for both P. vivax and P. falciparum; however, a direct anti-globulin test and anti-nuclear antibody test were positive, suggesting immune hemolytic anemia. After conservative treatment, which included a transfusion with packed red blood cells (RBC), his symptoms and signs showed improvement and laboratory findings were normalized.
Adult ; Africa ; Anemia, Hemolytic ; Angola ; Artemisinins ; Coinfection ; Erythrocytes ; Fever ; Headache ; Hematocrit ; Hemoglobins ; Humans ; Korea ; Malaria ; Mefloquine ; Plasmodium falciparum ; Plasmodium vivax ; Polymerase Chain Reaction ; Primaquine